Enucleation, Evisceration & Ball Implantation
- Enucleation and Evisceration (eye removal)
- Eye socket volume restoration
- Management of anophthalmic socket and ocular prosthesis
Frequently Asked Questions
What is enucleation and evisceration?
- Enucleation is the surgical removal of the eyeball.
- Evisceration is the removal of the contents of the eyeball, leaving the white “shell” of the eye, known as the sclera.
Why do I need an enucleation or an evisceration?
Your ophthalmologist will discuss your individual circumstances with you. There are several reasons why an eye or its contents are removed, for example to treat a painful blind eye, to treat certain eye tumors or severe eye injuries, to alleviate a severe infection inside the eye, or for cosmetic improvement of a disfigured and blind eye.
Is there an alternative?
Your ophthalmologist will only suggest removal of your eye after detailed discussion with you. The eye is only removed if all medical and conservative treatments have been tried and have failed. Sometimes this involves consulting other ophthalmologists.
Do I require an enucleation or an evisceration?
An enucleation is the preferred procedure to removed eye tumor. If your eye was injured due to trauma, there is a very small, theoretical risk of an inflammatory reaction to the other eye, and having enucleation could reduce this risk and therefore this is the procedure of choice.
In most other situations, either enucleation or evisceration can be performed. Your ophthalmologist will help you decide which surgery is most appropriate for you.
What should I do in preparation for surgery?
Blood thinning medications such as aspirin, clopidrogel (Plavix, Iscover) and warfarin can make bleeding more likely during and after surgery. If you are taking these drugs we may need to ask your GP or cardiologist if and when to stop these medications prior to surgery. You should also stop anti-inflammatory drugs like ibuprofen (Nurofen), fish oil, ginger, ginseng and garlic containing supplements 2 weeks before surgery.
What does the surgery involve?
Before your operation date, an anaesthetist will assess you and your surgical team will ask you to sign a consent form. On the day of surgery we mark your forehead with your consent to indicate which eye is to be removed. You would be given a general anaesthetic to put you to sleep during the operation. The operation takes about one and a half hours. You may be able to have the surgery as a day case and go home the same day or it may be desirable for you to stay in overnight especially if you live alone or if you have a long journey home. Your doctor will discuss which will suit you best at your consultation. It is advisable to be driven home by a friend or relative and not to travel home on public transport.
Is there anything I should not do after the operation?
After your operation, plan to rest avoid strenuous exercise. You cannot drive, operate machinery, drink alcohol or take sedative drugs for 24 hours. Do not swim for two weeks.
What will my eye look like immediately after it is removed?
During an enucleation, the muscles are left behind; after an evisceration, the contents of the eye are removed, leaving the white shell of the eye intact. An ball implant is usually placed inside the shell. This implant is a sphere made of either heat treated ocean coral, aluminum oxide, silicone or plastic. After an enucleation, the muscles of the eye might be attached to the ball implant to try to preserve some movement. This implant will be covered by your own eye socket lining (conjunctiva), giving a pink appearance. Sometimes a conformer (a clear, plastic shell) is put in place behind the lids while the socket heals.
The eyelids can be stitched closed to prevent too much swelling and the stitch is removed in the eye clinic a week or two after the surgery. The eye is usually covered with a pad for up to a week after your operation.
You can clean the lids with cool, boiled water to remove any mucus. You are advised not to touch the eye socket. You might wash the rest of your face normally.
What will my eye look like in the long term?
Once the eye socket has healed, about 6-8 weeks after your surgery, an artificial eye (prosthesis) will be made by an ocular prosthetist. The front surface of the artificial eye is custom painted to match the other eye. The back surface is molded to fit the socket for comfort and movement.
Will I need medication after my surgery?
You will be asked to take some medications after surgery such as eye drops, antibiotics, steroids, or pain-killers. Some patients are nauseated after the surgery which can be prevented or treated with medication.
What are the complications of enucleation and evisceration?
Short-term risks for this surgery, as with any surgery, include bleeding, swelling and infection. Long-term complications include discharge and socket irritation. There may be exposure of the ball implant which may require further surgery to treat.
When will I be back to normal after the surgery?
Time to recover from this operation can vary from person to person, in general it is recommend that you take at least 2 weeks off work to recuperate and return to work only when ready. You can discuss your individual circumstances with your ophthalmologist. It is advisable to wear special safety glasses to protect your seeing eye when playing sports or at work.
How do I look after my prosthesis (artificial eye)?
Most patients sleep with the prosthesis in place and remove occasionally as necessary for cleaning. It is easily removable, like a large contact lens. A prosthesis can last decades in many patients.
Will the artificial eye have movement?
There is usually an adequate range of eye movements although not as much as the normal eye.
What is the follow-up treatment?
You will be given a clinic appointment for one week after surgery.
How often will I need to visit the eye department?
Continued follow-up is important to check the eye socket lining for any signs of thinning, shrinkage or exposure of the ball implant. There may be a gradual loss of volume in the eye socket which can affect the fit of the prosthesis. Careful monitoring of the socket and prosthesis by the ophthalmologist and the prosthetist will help keep the socket healthy, and will allow for early detection of any changes that might require further treatment.
Who can I talk to for more information?
Please tell your ophthalmologist of any particular concerns that you have or if you need more time to consider your options. It is always best to try to write down any questions before your clinic appointment. If you require any further information or wish to contact any support groups, please ask your ophthalmologist or GP.
The eye, the eye socket or both may be partially or totally removed for several reasons. When this occurs, it is known as an anophthalmic socket. This method of treatment is chosen only after all other options have been considered, but in certain circumstances it does become necessary. The removal of the eye and sometimes part of the socket itself is occasionally performed in the following cases:
- Extreme trauma to the eye
- Severe and ongoing pain
- An existing prosthetic eye has lost volume and has sunk
The types of surgical procedures used in the removal of an eye include the following:
- Evisceration – the removal of a portion of the eye
- Enucleation – the complete removal of the eyeball
- Exenteration – the eye, muscles, soft tissues surrounding the eye and sometimes orbital bones are removed
Most patients who undergo the procedure have the removed eye replaced with an orbital implant and a prosthesis, or artificial eye. Orbital implants are attached to muscles and other structures in the eye socket so they feel secure. Patients are able to retain the ability to move the artificial eye. A prosthesis is designed and placed about six weeks after the surgical procedure, to allow for the healing of the socket tissue. Prostheses are often made of a biocompatible, non-toxic and non-allergenic material that provide a natural lookl. The prosthesis is custom-fitted and colored to match the patient’s other eye.