EYE REMOVAL AND SOCKET RECONSTRUCTION FOR SEVERELY DAMAGED OR DISEASED EYES

GENERAL CONSIDERATIONS

Removal of an eye may be required following a severe injury, to control pain in a blind eye, to treat some intraocular malignancies, to alleviate severe infection inside the eye, or for cosmetic improvement of a disfigured eye. This can be accomplished through either of two approaches. Enucleation is the surgical removal of the entire eye. This is the procedure of choice if the eye is being removed to treat an intraocular tumor or to try to reduce the risk of developing a rare, but severe, auto-immune condition called sympathetic ophthalmia following major trauma to the eye. In most other situations, either enucleation or evisceration can each achieve the desired objective. Evisceration is the surgical removal of the contents of the eye, leaving the white part of the eye and the eye muscles intact. This is often the procedure of choice as it yields more normal movement of the artificial eye that will eventually be dispensed.

SURGICAL TREATMENT

Enucleation and Evisceration are both performed under general anesthesia. After the entire eye is removed in enucleation, or after the interior structures and cornea are removed after evisceration, an orbital implant is placed in the eye socket to replace most of the lost volume associated with removal of the abnormal ocular tissue. The spherical implant can be made of silicone, polyethylene, or hydroxyapetite, and is covered by the patients own tissue in three layers. In many cases, the eye muscles are attached to the implant during enucleation, in order to optimally preserve eye movement (the muscle attachment remains unaltered during evisceration). Both enucleation and evisceration are performed under general anesthesia on an outpatient basis.

AFTER SURGERY

The eye is patched after surgery and the patch is changed once a day postoperatively. Following surgery, pain is negligible. The sutures are dissolvable, hence they do not require removal. Topical antibiotic ointment is used at bedtime. Six to eight weeks following surgery, an artificial eye (prosthesis) is fashioned by an ocularist. The prosthesis is of custom size and shape to fit the eye socket for maximum comfort and movement. The front surface of the artificial eye is custom painted to match the other eye. Patients can easily remove the prosthesis as needed for cleaning. Most patients sleep with the prosthesis in place. A prosthesis lasts for decades in many patients.

Enucleation and evisceration that is performed in conjunction with a hydroxyapetite implant have the option of incorporating an integrated prosthesis following surgery. This involves the surgical insertion of a motility peg several months after the original surgery. The front of this peg is subsequently fit into a small concavity on the back of the custom prosthesis. This fixes the implant directly into the prosthesis in order to achieve better movement of the artificial eye.

RISKS AND COMPLICATIONS

Minor bruising or swelling may be expected and will likely go away in one to two weeks. Bleeding and infection, which are potential risks with any surgery, are very uncommon. Subsequent socket irritation from the prosthesis or exposure of the surgical implant can occur, but are quite uncommon. These developments are slightly more frequent in cases incorporating an integrated prosthesis.

CONCLUSIONS

In cases requiring removal of the eye, evisceration and enucleation (with or without an integrated prosthesis) are safe and effective means to reestablish normal socket volume and availing a prosthesis effectively matched to the other eye.