Eye Removal (Evisceration or Enucleation)
There are several reasons why an eye would need to be removed. One of the most common reasons is to alleviate a painful eye that is blind due to diabetes, chronic retinal detachment, trauma, or other conditions. Growth of a tumor in the eye, non-remitting infection, or certain injuries can also necessitate more urgent eye removal.
What Are Evisceration and Enucleation?
Evisceration is the surgical removal of the cornea and internal contents of the eye leaving the sclera (white of the eye) behind. This removes all sensory components to alleviate blind eye conditions due to benign causes. A spherical implant is inserted in the remaining socket to replace the volume of what was removed. The outcome from this procedure leaves more of the body’s natural volume in the eye socket behind, necessitating less bulk from the implant fashioned by our ocularist. It also leaves the muscles that move the remnant socket attached at their natural positions, allowing more motility of the remaining eye socket structures. There are certain contraindications to proceeding in this fashion, so your surgeon will discuss if you are a candidate.
Enucleation is the surgical procedure by which the entire eye is removed, including the sclera. The muscles that control eye movement are left behind and intact and are attached to the spherical implant or to the remaining eye socket tissues to increase motility of the residual eye socket contents.
In both procedures, a conformer (a temporary plastic prosthetic) is placed over the implant to aid in healing and to act as a placeholder until a custom prosthetic is fitted about eight weeks later. The eyelid may be sewn shut to hold the conformer in place and assist with wound healing. To protect the wound, prevent bleeding, and reduce inflammation, a large pressure bandage will be taped over the eye.
Either surgery is typically an outpatient procedure performed under general or local anesthesia and normally takes about an hour.
Are There Any Risks with Eye Removal Surgery?
The decision to remove an eye can be one of life’s most difficult decisions. While evisceration or enucleation is performed to save a person’s life, to relieve pain, or treat disease, it is not without risks. Your surgeon will discuss with you in detail the risks involved, but some of them can include:
- Difficulty closing your eye
- The implant falling out
- Need for additional surgeries
Preparing for Eye Removal Surgery
Prior to eye removal surgery, you will want to discuss with your surgeon what medications you are taking and which, if any, should be discontinued prior to surgery. In addition, you will want to schedule an appointment with the ocularist before the surgery so the process to fit you for a prosthetic is underway.
After Eye Removal Surgery
After eye removal surgery there will likely be swelling, bruising, and mild discomfort. A pinkish or watery discharge may occur, and the socket may have a scratchy feeling. These aftereffects are normal and should go away in a few days.
Your surgeon may prescribe medications to prevent infection or otherwise aid in recovery. A bandage will be placed over the treated eye for up to one week. It is important to keep this bandage on as long as directed and to keep it dry. Take care not to bump, press, or rub your eye socket. There will be a follow-up appointment with your surgeon within the first week to evaluate how you are healing.
Your surgeon will have recommendations for you regarding specific restrictions, but standard restrictions include no lifting, bending at the waist, pushing, pulling, or other strenuous physical activity for the first one to four weeks after surgery.
For most patients, the healing process will take six to eight weeks, at which point you can be fitted for a prosthetic. Part of the Dean McGee Eye Institute difference is that we have a board-certified ocularist on staff with whom our oculoplastic surgeons partner to provide you with a comfortable, realistic prosthetic. To learn more about the prosthetic process, visit our Ocular Prosthetics page.
You will want to visit your surgeon and ocularist once or twice per year for a regular checkup regarding the health of your eye socket and the fit of your prosthetic.
Evisceration and Enucleation at the Dean McGee Eye Institute
Evisceration and enucleation are often procedures of last resort, requiring special skill and precision during the surgery and with regards to the process of fabricating and fitting a prosthetic eye afterward.
Our team at the Dean McGee Eye Institute understands the emotional weight of having an eye removed, along with the joy that comes from receiving a lifelike prosthetic to replace it when the time comes. We will be with you every step of the way and would be honored to care for you or your loved one.