Enucleation

Enucleation refers to the surgical removal of an eye. This procedure is generally recommended only when there is no other choice. Enucleation is usually performed for several different reasons: to remove a malignant tumor that has developed within the eye; to alleviate intolerable pain in a blind eye affected by a condition such as uncontrollable glaucoma; or to reduce the risk of "sympathetic" inflammation of the remaining eye when one eye has been severely injured and blinded.

Removal of an eye is considered a drastic and traumatic measure to most people. Although many patients who require this surgery have no vision in the affected eye, those who do have vision recognize that enucleation will result in instantaneous, permanent, total blindness of that eye. Furthermore, all patients who undergo this procedure will require an artificial eye (ocular prosthesis) as a cosmetic substitute for the real eye.

Surgical Procedure

Enucleation is usually performed under general anesthesia, although it can be done under local anesthesia by numbing the entire eye and socket tissues prior to the surgery. The procedure generally takes no more than 45-60 minutes.

Immediately after the eyeball has been removed, an orbital implant, only slightly smaller than the eye, is inserted deep in the socket. Muscles are attached to the implant to improve motility. The implant is covered externally with conjunctiva, the pink surface tissue that lines the eyelids and is similar to the inner lining of the mouth.

Back to Top

Postoperative Care

At the completion of the enucleation, a pressure patch is applied over the eyelids. This patch is intended to keep swelling of the socket tissues to a minimum. It is generally kept in place for about one to four days after the surgery. During the time this patch is in place, the patient commonly experiences some difficulty opening the lids of the unoperated eye. This can be quite frightening to the patient, who is effectively blind in this situation.

Fortunately, the difficulty in opening the eyelids generally resolves itself after the first post-operative day. Moderate postenucleation pain in the socket generally occurs during the first 24 hours, but pain relievers are usually prescribed as needed to reduce this discomfort.

After the pressure patch is removed, the eyelids are usually swollen and black-and blue for a few days. The use of ice compresses on the eyelids generally helps to reduce the swelling rapidly. Eyedrops or ointment which promote healing of the socket tissues are usually started as soon as the pressure patch has been removed.

Back to Top

Orbital Implants and Ocular Prostheses

Following enucleation, the eye is replaced with an orbital implant to fill the empty socket.

The cosmetic artificial eye (ocular prosthesis) is a plastic device that is molded to fit between the eyelids over the conjunctiva that covers the ball implant. This prosthesis is generally made two to six weeks after enucleation, in order to allow the socket tissues time to heal adequately. Prior to that time, a thin plastic plate (conformer) is usually worn in place of the prosthesis. This conformer helps to prevent shrinkage of the space between the inner surface of the lids and the conjunctival covering of the ball implant. Until the ocular prosthesis is fitted, the upper eyelid may be droopy. The prosthesis supports the eyelid and generally allows the lids to open and close normally.

Some of the older implants, such as plastic or silastic, have a natural appearance when the patient looks straight ahead, but do not move like the opposite eye, since they are not integrated.

However, newer types of orbital implants allow movement of the artificial eye. These prostheses are called integrated orbital implants, such as Medpore or hydroxyapatite (Bio-Eye).

Integrated Implants

The newest orbital implants are made of hydroxyapatite (Bio-Eye) or porous polyethelene (Medpore). It is inserted into the patient's orbit immediately following enucleation. The muscles that move the eye are then sutured around the implant. As with other implants, after about four weeks, the ocularist inserts a temporary prosthesis between the eyelids over the implant.

In about six months, when blood vessels have grown into and around the implant, a small hole may be drilled into the implant, so that a peg can be inserted under local anesthesia. (This is done rarely.) The prosthesis is attached to the peg like a ball and socket joint. It transmits the movement of the implant to the overlying prosthesis, so that it moves along with the patient's other eye. The peg also helps to support the weight of the prosthesis, which may prevent the lower eyelid from sagging.

Some tearing of the eye is normal once the prosthesis is in place. In some patients, thick mucus may build up on the prosthesis requiring that the artificial eye be removed and washed off from time to time. In most instances, mucous buildup can be washed off the prosthesis and out of the socket by using an irrigating solution without removing the prosthesis. However, most patients remove their prosthesis for cleaning once every one to three months.

Not all patients are candidates for this type of implant. Your physician will evaluate what is best for you.

Back to Top