Dotting Eyes, Crossing Teeth
If eyes are the mirrors of the soul, then Louis Gilbert is a soul maker. From his dental laboratory at Walter Reed National Military Medical Center he is busy; creating handmade, lifelike prosthetic eyes that would make any soul proud.
He completed the NPDS maxillofacial laboratory prosthodontics course in 2000. The six-month course allowed him to expand his dental technician skills while learning the ins and outs of painting and creating facial prosthetics, which involves using the same materials as those used to make dentures.
Mastering the Eyes
Gilbert learned to master the various aspects of maxillofacial prosthodontics, but was very interested in "mastering the eyes," he said.
"It was more appealing to me. It was more creative," he explained.
After retiring from the Navy after a 20-year career, Gilbert began working as a Department of Defense civilian in 2006 at the former Walter Reed Army Medical Center that was located in Silver Spring, Maryland. Now in Bethesda, Gilbert has continued working with other skilled anaplastologists, who specialize in producing and fitting facial prosthetics.
The team here decided they would each concentrate on a particular aspect of their craft, with Gilbert focusing primarily on prosthetic eyes, or ocular prosthetics. Some of his colleagues have mastered silicone work, while others are able to make "specialized" eyes - like a Marine emblem or sports team logo superimposed on the iris of a prosthetic eye. Patients have even asked for glow-in-the-dark prosthetic eyes, Gilbert said.
Constructing a Prosthetic Eye
The process of making a prosthetic eye typically takes about eight hours, Gilbert said. Also referred to as an ocularist, he begins by making an impression of the eye socket, where the eye is missing. He uses an alginate, or wax-like, casting material, to make the impression. Gilbert can easily heat up this material and reshape it during the fitting process, if need be, he said. He will later use this impression to make a mold of the eye.
Gilbert then sits in front of the patient, using the remaining eye as a guide as he paints the patient's iris on a small "canvas," a round circular fabric, about the size of a pinky nail. He might also use a photo of the patient's remaining eye, as a guide. He ensures to capture every intricate detail of the iris, using oil-based paints. He also measures the patient's iris and pupil, on the remaining eye, to ensure the prosthetic matches.
Once he's finished painting the iris, he superimposes a "pupil" on top of the iris. A small round, acrylic dome is then placed over the iris and pupil, magnifying the colors. Altogether, the pupil and iris are attached to the mold. Gilbert then inserts the mold into the eye socket to check the alignment of the iris. He calls this part of the process "setting the gaze," making sure the iris is aligned properly.
Painting the Eye
Gilbert then completes the mold by painting the sclera, the white part of the eye. He has about a dozen shades of acrylic paint to choose from for this part of the eye, including dark greys, yellows and different shades of white. He then uses red strands of thread to create veins in the eye, and finally, he adds a clear coat over the eye to seal the prosthetic.
"The goal is to be as natural and look as normal as possible, and to be comfortable," Gilbert said.
If there is no damage to the muscles behind the eye, then the prosthetic eye should still be able to move normally as well, he said. Gilbert will continue to see his patients within the months following to ensure proper fit, as post-surgery swelling continues to go down. Long term, patients usually return about once a year for polishing and to ensure the eye still fits properly.