Factors associated with ocular prosthesis motility in anophthalmic patients: a multivariable analysis

Purpose To identify the clinical, anatomical, and prosthetic factors independently associated with ocular prosthesis motility in anophthalmic patients. Methods This prospective cross-sectional study included 107 patients with unilateral anophthalmia wearing acrylic prostheses. Horizontal prosthesis motility was graded relative to the fellow eye by three independent masked examiners using a five-point ordinal scale. Candidate predictors associated in univariate analysis (p ≤ 0.10) were entered into blockwise multivariable regression across five domains: clinical background, socket and eyelid findings, socket motility parameters, prosthesis primary gaze alignment, and prosthesis structural dimensions. Results Independent predictors of prosthesis motility were socket temporal motility (β = 0.36, p < 0.001), time since anophthalmia (β = –0.23, p = 0.003), prosthesis primary gaze alignment (β = 0.21, p = 0.002), socket downward motility (β = 0.20, p = 0.027), inferior fornix depth (β = 0.19, p = 0.007), and levator function (β = 0.15, p = 0.042), together explaining 67% of the variance in examiner-rated prosthesis motility (adjusted R 2 = 0.64). Prosthesis dimensions, demographic variables, and orbital implant status did not retain independent significance. Conclusion In this study, prosthesis motility was primarily associated with socket dynamics, structural socket capacity, eyelid function, and chronicity of anophthalmia. These findings highlight the importance of multifactorial clinical assessment when evaluating prosthetic eye movement as part of visual and cosmetic rehabilitation after eye loss.