Enuclation and evisceration are performed by an oculoplastic surgeon. Afterwards, the orbit is reconstructed and a prosthetic eye, with some limited movement, is inserted.
Very rarely, when a tumour extends beyond the eye and affects the orbit, an exenteration may be necessary. This is the most radical of the three surgeries, consisting of removal of the whole content of the orbit (eyelids, eyeball, muscles, fat, optic nerve etc.).
A blind eye is not always painful and does not always need to be removed. However, if it is unsightly a cosmetic shell can be placed in front of it that looks like a normal eye. Sometimes removal is recommended anyway if the best cosmetic result is with an orbital implant and prosthetic eye.
Following trauma the oculoplastic surgeon may recommend removal of the eye even if there is no pain.
A Blind Eye / Loss of an Eye
Very rarely an eye will be severely diseased following severe eye infection, retinal disease or detachment, be severely injured or contain a tumour, and may have to be removed. The eye can be blind and painful or blind and not painful.
A patient may loose an eye in childhood from a tumour such as retinoblastoma or trauma, whereas in adults the most common cause is trauma or a diseased eye such as severe diabetes, recurrent retinal detachment, severe infection inside the eye called endophthalmitis.
If the blind eye is not painful and inflamed but is looking unsightly, a cosmetic shell can be placed in front of it to look like a normal eye. Removal of the blind eye may be recommended if the best cosmetic result can be obtained with an orbital implant and subsequent ocular prosthesis (artificial eye or “glass eye”).
Following eye trauma if the contents of the eye are severely disrupted and cannot be put back into their normal place surgically and has no vision or no visial potential, the oculoplastic surgeon may recommend removal of the eye even if there is no pain. This is recommended if there is a risk of subsequent loss of vision in the good eye from sympathetic ophthalmia.
The oculoplastic surgeon will advise whether removal of the whole eye or its contents only is best. If there is concern, a second ophthalmologist opinion is requested.
Definitions of types of eye removal:
Enucleation: Removal of the entire eye including its scleral (white) fibrous coat. The eye muscles are detached and usually reattached to an orbital implant.
Evisceration: Removal of just the diseased or injured contents of the eye is called evisceration if the scleral cover with attached muscles is preserved.
A thorough history will be taken, noting any previous trauma or previous tumour. Vision will be measured and both eyes fully examined. The pressure of the eye may be measured, as this may be abnormal in a blind eye.
If the condition can be treated without treatment, this is preferable.
Enucleation or evisceration is only recommended when all other eye treatments have been considered. Exenteration is very uncommon.
A painful blind eye can sometimes be made comfortable with eye drops and tablets to reduce inflammation and redness and to rectify any pressure changes.
Enucleation is the partial surgical removal of an eye.
Enucleation is usually performed under general anesthetic, although it can be done under local anesthetic. The procedure takes up to an hour.
An orbital implant replaces the volume of the eye removed and can be made from various materials. Occasionally fat from your own body is used to replace the volume lost. Muscles are attached to the orbital implant so that the ocular prosthesis will move with the other eye. The orbital implant will not be visible.
If necessary a prosthetic shell can be fitted neatly in front of the implant, behind the eyelids, looking like a normal eye.
Evisceration is the complete surgical removal of the eye, including the lens, iris, vitreos jelly, retina. The white scleral coat to which has the eye muscles are attached is not removed but used to cover the implant.
In very rare cases, when a malignant tumour affects the orbit as well as the eye itself exenteration may be necessary. This is removal of the whole content of the orbit (eyelids, eyeball, muscles, fat, optic nerve etc.). This radical surgery is to avoid the tumour spreading any further. Reconstructive surgery will also be performed to restore appearance.
Post-operative care and follow up after enucleation and evisceration
- Firm eye patch for 2 – 5 days.
- Antibiotic tablets and anti-inflammatory tablets (usually steroids) are prescribed for between 5 and 10 days.
- Eye drops are started once the eye patch is removed.
- The eyelids look quite closed (eyelid ptosis) for the first few weeks.
- The periorbital area is swollen and bruised for 5 – 10 days.
- A clear plastic shell or conformer is placed in the space between the eyelids for the time between the operation and fitting of the ocular prosthesis (artificial eye) 8-12 weeks after surgery.
- The ocular prosthesis is custome made for each persons socket. A prosthetist makes a mould of the space behind the eyelids and hand makes and hand painst an ocular prosthesis to match the remaining good eye.
- If both eyes are lost which can occur rarely, the prosthetist uses old photos to match the eye colour.
- You should not drive for 48 hours after your surgery. You should have someone accompany you home.
You should not swim for one month
What does the procedure involve?
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