Enucleation and Evisceration
Why do patients decide to have Eye Removal Surgery?
Deciding to have surgery to remove an eye can be a psychologically and emotionally challenging decision. Your ophthalmologist will always try to save an eye and restore vision, but in certain cases, it may not be possible. Some of the reasons why patients and their ophthalmologists decide on eye removal surgery include:
- A “blind painful eye”–chronic eye pain can severely affect your quality of life
- Cancer of the eye—eye removal can sometimes prevent cancer from spreading throughout the body
- Uncontrolled infections inside the eye—eye removal is sometimes the only way to stop aggressive infections from spreading throughout the eye socket and to the brain
- Severe eye trauma and rupture—eyes that are damaged beyond repair may require removal
How are Enucleation and Evisceration Different?
Evisceration: This surgery removes the cornea and contents inside the eye but leaves the white outer layer of the eye (the sclera) intact. The muscles that move the eye stay attached to the sclera. A spherical implant is placed in the socket to restore volume, and patients are later fit with a prosthetic eye.
Enucleation: This surgery removes the entire eye including the sclera. This involves detaching the muscles that move the eye. A spherical implant is placed in the socket to restore volume, and the muscles are reattached to the implant. Patients are later fit with a prosthestic eye.
Both surgeries involve placing a spherical implant in the socket and making a prosthetic eye that will have some movement.
Dr. Lee will discuss these two surgical options and help you decide which one would be best for you based on your individual condition.
How Does Eye Removal Surgery Work?
The surgery is done in a surgery center with IV sedation and a local anesthetic injection/nerve block that completely numbs the eye and eye socket. The surgery takes approximately 1 hour. At the end of the surgery, a small plastic disc (conformer) is placed in the socket to maintain the space for the eventual prosthetic. A pressure patch is placed over the socket and left on for the first week.
Patients go home the same day and are given pain medications to help ease any pain or aching for the first few days after surgery. They return to clinic 1 week after surgery for patch removal. About 6 weeks after surgery, patients will see an ocularist, an artist who makes prosthetic eyes. The ocularist makes a custom-fit prosthesis based on the socket and then paints it to match your other eye as closely as possible. In many cases, it is quite difficult to tell which side is the prosthetic vs. an actual eye.
What other care or precautions are recommended for patients who have had eye removal surgery?
The ocular prosthesis should be polished by the ocularist every 6 months to remove any scratches, proteins, or deposits on the prosthesis. This will ensure that the prosthesis is comfortable and not causing irritation or excess discharge.
Patients should also have regular dilated eye exams with their general ophthalmologist for their remaining eye. This will help with early detection and treatment of any eye diseases to preserve vision in the remaining eye.
All patients who only have one eye that sees well should use polycarbonate safety glasses at all times to prevent accidental eye trauma. Freak accidents can occur at home, while driving, or out in public, and there is no back-up eye if the remaining sighted eye is injured or lost.
Will I ever need any further surgeries for my eye socket?
Many patients who have undergone eye removal surgery may eventually need another surgery. This could include:
- Implant exchange: if the original implant placed becomes exposed, infected, or does not provide adequate volume, it can be exchanged for a new implant.
- Ectropion repair: the prosthesis can cause the lower eyelid to become more lax over time. If this happens, the prosthesis may start to spontaneously fall out of the socket, and the lower lid can be tightened to help retain the prosthesis.
- Contracted socket surgery: if the socket has significant scarring from prior surgeries, or if the prosthesis is not used regularly, the socket can contract. If this happens, it may be difficult to fit the prosthetic into the socket, and surgery may be necessary to enlarge the socket to allow the patient to wear a prosthesis.
What is the “down time” after Enucleation or Evisceration Surgery?
Patients may have some pain and nausea for the first several days after surgery that can be controlled by medications. A week after surgery, the patch is removed, and antibiotic ointment is applied to the socket twice a day for 2 weeks. Patients should expect some bruising and swelling for at least 1-2 weeks.
Patients can walk around the same day of surgery and do light activities, including using the computer or watching TV. They should avoid heavy lifting, straining, or bending for the first 2 weeks. The sutures typically dissolve on their own.
Schedule Your Consultation Today
If you are considering eye removal surgery, schedule your consultation today to learn more about how Dr. Lee may be able to help you. It is not uncommon to hear patients after eye removal surgery say “I should have done this long ago.” This is because chronic eye pain, tearing, and an abnormal-appearing eye can really be a difficult burden to bear. Being able to live without eye pain and with a great looking ocular prosthesis can help patients regain their confidence and quality of life.