Gunderson Flap

[hawk]

Has anyone had gunderson flap surgery, and been fitted for a prosthectic eye?

This is my first message posted.

[nancyann]

I had to look up Gunderson Flap - had no idea what it is.  Apparently it's a flap taken from the conjunctiva & placed over the cornea to protect it for prosthetic eye placement.
So, I personally would wonder if it could be used to protect the cornea WITHOUT needing a prosthetic eye, just for protection (& then maybe decreasing the need for lubricants, drops).  I don't know how a conjunctival graft would look aesthetically.   I'll have to ask my opthomologist about it when I see him in a few weeks.   Most/all of us here with eye issues have them because our eyelids don't close fully or have dry eye, or both.   Many have used a punctual plug/drops/lubricant if it's only a dry eye issue; others (like me) have had a weight placed in the upper eyelid to help the eyelid close.   I personally haven't read of anyone requiring a prosthetic eye for AN surgery complications.   
Take care,  Nancy

[lori67]

I had to look it up too.  Never heard of it.  I see (sorry, poor choice of words, here) from your signature that you've already had it done.  Was it as a result of your AN, or something else?  I'm sure you could teach a lot of us here about it.

Sorry I couldn't be more help.
Lori

[nancyann]

Sorry Mark,  I didn't see your signature at the bottom of your post.   You had your surgery 9 years before me.  I too am curious if it was due to complications from AN.
I also had my 1st weight removed (gold allergy), but recently replaced with platinum.   So, I'm also wondering how come the docs opted for this procedure & (more importantly), how you feel about it.    I for one am interested in the flap (as I mentioned earlier) to help decrease/stop the need for constant lubricant use.  The eye issue has been ongoing & getting on my nerves.

[hawk]

Yes, the gunderson flap is the result of Acoustic Neuroma surgery.  I had severe cornea ulcers, and didn't even realize it until seeing a surgeon regarding the 7-9 nerve surgery.  He was quite shocked that the eye was even intact after seeing the ulcer.  He sent me to and optamologist right from his office.  I had my eye sewn shut on 4 occasions, both partial and complete.  Gold weight was attempted, but it was uncomfortable and still not giving me sufficicent closure.(You would of never realized how strong your eyelids are if you didn't have an surgery.  They are like springs)  I was sent to a specialist who suggested the Gunderson Flap.  At this time, I felt like someone was sticking a vacum in my eye and sucking out all of the moisture.  I decided to go with it, and it was a great decision.  You still need tears, but a bottle of tears lasts me one month.  There are some cosmetic issues, and daily cleaning of the prosthetic.  If you want to hear more, I would be glad to continue later.  I was just so impressed that someone responded so fast.  I have to step out.  I will continue if you want to hear more, or if you have questions, when I return.(One more thing, I am trying to post a picture to my profile.  Any suggestions?)

[nancyann]

YES, I WANT TO HEAR MORE...   Did you eventually lose your vision due to the lengthy time of untreated corneal ulcers?  or did they put in the weight hoping to protect the cornea & you still had vision?   (My eyelid has never closed completely with either the gold or platinum weight - I'll be looking into a heavier weight..)
Are you able to 'blink' now with the prosthetic eye, or do you still not have a complete blink?   
You said there are cosmetic issues, what are they? (other than cleaning the eye).   
I appreciate your enlightening us about this.  Eye issues are a big thing to many of us, especially those of us with chronic facial paralysis.
This may sound odd, but,   how come it was a great decision?  (I like hearing that by the way!)
Thanks for your input Mark,   Nancy.

ps:  I've used an 'eye bubble moisturizer' at night for months, one night recently my eye began burning from it, I've gone without it for 1 week, but it's difficult to sleep with the eyelid open (+ my eye dries out without it), so I'm going to try the bubble again & see what happens....
pss:  how did the nerve graft work out?  I recently had a surgery called 'temporalis tendon transfer',  I still have the paralysis, but my face doesn't have the droop anymore, & eventually I'll have a 'Mona Lisa' smile when I bite down (once the swelling subsides).

pss:  sorry, I can't help with loading pictures, someone did mine for me,  I'm still quite computer illiterate....  got my 1st computer 8/06, post AN.....

[hawk]

It was a great decision, because the flap protects the eye.  I can swim without the prothetic in.  I remove the eye prior to sleeping and the gunderson flap protects the eye from drying up.  don't get me wrong, tears in the eye feel good, and I still use them.  If you had glasses with a tint, you may not need the eye all the time.  I have prescription sunglasses, and never where my eye during the day outside when I am able to wear my prescription sunglasses.

I occasionally use torbodex liquid or salve if the eye becomes to inflamed.  This is a steroid and should not be used on a regular basis. 

You would need a good occularist that knows how to make a good eye.  This is usually a very thin sclereo shell.  It is removed with a suction cup.  The eye is made of plastic, and I clean it with dial pump soap.  I store it at night or when not in use in a cup with lid in water.  Regular tap water is fine

I do need to go back in for tightening of my lower lid.  It has drooped a bit over the past 10 years.  Regarding cosmetic issues.  The eye does look good, however it is not like a real one of course.  But, overall it was a good decision.  I have also had some of my eyelashes cauterized.  Who ever knew that eyelashes were like little pine needles.  After having my eye sewn shut, some eyelashes decided to curl inward toward the eye.  Ridding them gave me comfort. 

I have facial paraylisis on the left.  During my second surgery, my ENT and Nuerosurgeron removed all the bones in the left ear and sewed the hole shut.  I have severe directional hearing loss, but they felt it to be necassary as to prevent any future growth of cells. 

I still had vision in my eye, however the right eye was 20/20 corrected, and it was an option to heal the left eye.  The left eye was losing vision, and like I said, there was no pain, but it felt like someone was sticking a vacum in my eye and removing any moisture.  It actually felt abrasive to me.  I tried a heavier weight, however it still didn't work well, and was uncomfortable. 

[nancyann]

Mark:  Thanks for the info.    I'm curious,  what does the eye look like without the prosthetic in?  & does your eyelid blink or no?

When eyelashes land in my eye it's really annoying because they 'stick' & I have to drown the eye with drops, then take a tissue to gently remove the eyelash (I hate when that happens).   I've been thinking about having my eye sewn shut if these eye issues continue,  but vanity has stopped me so far.  Hearing that eyelashes can turn inward is making my decision NOT to do it even easier, geez louise....

Most of us have single sided deafness post surgery, & can't tell where sound is coming from either...   I haven't chosen to get a hearing aid yet,  the SSD isn't as bad as the other issues I'm dealing with right now & I'm not really bothered by it,  yet.....   Still have good hearing in the other ear...

[lori67]

Mark, I had the same problem with eyelashes going inward after my tarsorrhaphy.  It constantly felt like there was something in my eye, but I could never see anything and it never came out with eye wash, so I figured i just had to live with it.  When i went to my eye doctor just for a regular vision screening he told me that 2 of the lashes were sticking directly into my eye!  Well, no wonder!  He pulled them out and suggested I go back to my eye surgeon to have something done to permanently stop growing.  I felt immediate relief after he yanked those suckers out!  But they will grow back, so I have to get back to the surgeon.  You said you had them cauterized?

Sorry, I can't help with the picture either.  As you can see,I haven't figured it out yet either, but I'm working on it.  If I figure it out, I'll let you know, but I don't suggest you hold your breath for that!! 

Lori

[hawk]

Ok, first the eye looks like a big dot without the cornea, and the color of the white part of your eye does have some red in it.  You see, during the surgery they remove the cornea, and turn in backwards back on the eye.  Then they take the skin from your eye which is the white part, and they sheath layers of that over the upside down cornea to protect it, and to also give you a good base to put the sclereo shell(Prosthetic Eye) on.  I don't like the appearance without the shell.  But once the shell is in---presto you have a new eye that looks pretty good.  My eyelid does not blink, however after having the 7-9 nerve graft, I do have some movement to my eye and face depending how I move my tongue and jaw.  I had a severe droop prior to the graft.  This really helped me out.  The nerve takes 7 years to regenerate.  It grows about 7 inches and averages 1 inch a year to complete.  So, every year made a difference.  Slow process yes, but worth it. 

Cauterization is where they remove the eyelash permanently.  They did mine while at the opthamolgist office. sitting right in the chair.  Instant relief.  I do have plenty of eyelashes left.  I also remove some of mine on my own when they are bothering me.  I pluck them out with the shell in, so I don't injure my eye in any way. 

I am not a doctor, but if I had my choice, I would of never of had my eye sewn shut.  Yes, I think at the time I had to because the cornea ulcer was so intense.  However the surgery did alot of damage to my eyelashes.  You just don't realize how important those lashes really are. 

I never remove eyelashes with a tissue if in the eye.  I usually opt for a cotton swab that you would use to clean out your ear with.  It is more gentle, and you can really focus on getting the lash, instead of just swiping with a tissue.  You can even put a little tear goop on the end of the swab to stick it to the lash to pick up.  Plus, you are giving your eye some tears. 

[nancyann]

Mark:  Thanks for all the info.   I guess in my case, having the gunderson flap would be a bit radical at this point, for you I understand the necessity (my cornea is ok so far).
You have really been thru alot with the AN complications, I give you alot of credit,  you sound great, have accepted it all (I on the other hand am still working on that).
Hopefully time will heal the physical & emotional wounds I'm still dealing with.

I'm glad to hear the nerve graft worked for you.   I was too scared to go that route, so I opted for the temporalis tendon transfer (I had a really bad droop pre-op also).

I will try using a cutip with a little lubricant on it to get the eyelashes out of my eye, thanks for the heads up.  I've had the lower lid tightened 3 times in 1 1/2 years, I hope I won't need it done for awhile.   One person in this forum's opthamologist put cartilage from her ear in the lower eyelid & it has kept her lower lid from drooping.   An eye surgeon I consulted with uses the upper palate of the mouth to hold up the lid.   I'll have him do that for me if my lid begins to fall again.

So, welcome to our group, hope you stay in touch, you are a wealth of information &, as Lori said, have much to teach us.

Always good thoughts,  Nancy

[luv2teachsped]

hello all:
      Been a while since I have posted.  I too , am tired of eye problems!  I have no gold weight etc... as my eye does shut, but has no tears.  I have spent almost every month for the past three years in my eye Dr.'s office.  I use lubricants, gels and drops.  This winter ,I have had  more problems than ever.  Is it the dry air or what?   The last time I was in my Dr.'s office, he said there was nothing else he could do. Meanwhile, my eyes itch and burn constantly. Ant suggestions?  I've read all the past posts. It seems like a lot of others have this very same problem.Thanks for listening! luv2teachsped

[nancyann]

Have you asked your opthomologist about Restasis drops? ( with continued use they're suppose to help produce tears), or having punctual plugs put into your tear ducts?   I'm not a candidate for either because my eye makes tears, but they're useless because I can't blink, they just fall out of my eye.

[hawk]

The gunderson flap was the best for me.  However not for everyone.  Please do some research on it via the internet, and I can answer any questions.

Mark

[lori67]

I went to the opthamologic plastic surgeon and he cauterized my tear ducts.  He said if you want to keep the water in the sink - you have to plug up the drain - same thing with your eye.  I do make some tears on that side, but not the normal amount yet and yes, they do run down my cheek every now and then, but the amount of relief from the dryness is worth every drip!  I don't have to use drops during the day at all and I just use gel at night.  My heater seems to make the air really dry in my house too, so I use a humidifier at night and that helps.

(I just typed this all out - and somehow it vanished into thin air - so sorry if it shows up twice!!)
Lori