Removal of Eye Surgery Enucleation / Evisceration
What Is Removal of an Eye Surgery (Enucleation or Evisceration)?
When an eye is removed surgically, it is typically done for medical reasons, such as to treat severe eye injuries, advanced eye diseases, or eye cancer. The procedures for eye removal include enucleation, where the entire eyeball is removed, or evisceration, where the eye’s contents are removed while the outer eye structure is preserved. Following the removal of an eye, an ocularist can create a custom ocular prosthesis (artificial eye) to replace the missing eye, providing a natural appearance.
What Is an Enucleation?
Enucleation is a surgical procedure in which the entire eyeball is removed from the eye socket (orbit). This procedure is typically performed for medical reasons, and it may be necessary when an eye is severely damaged, infected, or affected by advanced eye diseases or eye cancer. Enucleation is carried out by an ophthalmologist or oculoplastic surgeon who specializes in eye surgery. Here’s an overview of the enucleation procedure:
Indications for Enucleation:
Enucleation is considered when an eye has significant damage or disease, such as:
- End-Stage Eye Disease: Enucleation may be performed when the eye is affected by advanced glaucoma, severe retinal detachment, or other conditions that have caused irreversible vision loss and are causing pain or discomfort.
- Eye Trauma: Severe trauma or injury to the eye that cannot be effectively repaired through other surgical means may necessitate enucleation.
- Eye Cancer (e.g., Retinoblastoma or Intraocular Melanoma): Enucleation is often used to remove an eye affected by eye cancer to prevent the spread of the cancer to other parts of the body.
The Enucleation Procedure:
During enucleation, the following steps are typically followed:
- Anesthesia: The patient is placed under general anesthesia to ensure they are comfortable and pain-free during the procedure.
- Removal of Eye: The surgeon makes an incision around the eye, typically along the natural eye contours. They disconnect the eye’s muscles and optic nerve.
- Implant Placement: After removing the eye, an orbital implant is often placed in the eye socket to maintain the natural eye shape and volume. The implant is secured in the socket, and the muscles that control eye movement are attached to it.
- Closure: The incision is carefully closed with sutures, and the surgeon takes care to ensure that the eye socket appears symmetrical and natural.
- Artificial Eye (Prosthesis): After the enucleation surgery, an ocularist, who specializes in making custom ocular prostheses (artificial eyes), will create an artificial eye to fit the empty socket. This prosthesis is designed to match the color and appearance of the remaining eye, providing a natural look.
Enucleation is a significant surgical procedure and is typically considered after all other treatment options have been exhausted. It is crucial for individuals undergoing enucleation to receive support and counseling to adapt to the changes in their appearance and learn how to care for the artificial eye.
What Is an Evisceration?
Evisceration is a surgical procedure that involves the removal of the contents of the eye, leaving the outer structure of the eye intact. During evisceration, the eye’s natural shell, including the sclera (white part of the eye) and the cornea (clear front part of the eye), is preserved. The procedure is typically performed by ophthalmologists or oculoplastic surgeons and is used for medical reasons when the eye’s contents need to be removed while maintaining the eye’s structural integrity.
Indications for Evisceration:
Evisceration is considered when there are specific medical indications for removing the contents of the eye while retaining the outer shell. Some common reasons for evisceration include:
- End-Stage Eye Disease: When an eye is affected by severe eye diseases that have caused irreversible vision loss and are causing pain or discomfort, such as end-stage glaucoma or retinal detachment.
- Eye Infection: In some cases, a severe eye infection may necessitate the removal of the eye’s contents to prevent the infection from spreading to other parts of the body.
The Evisceration Procedure:
The evisceration procedure typically follows these steps:
- Anesthesia: The patient is placed under general anesthesia to ensure they are comfortable and pain-free during the procedure.
- Removal of Eye Contents: The surgeon makes an incision around the eye, often along the natural eye contours, to access the interior of the eye. The eye’s contents, including the vitreous humor (the gel-like substance inside the eye), the lens, and other structures, are carefully removed.
- Implant Placement: An orbital implant is usually inserted within the eye’s shell to maintain its natural volume and shape. The implant is secured, and the muscles that control eye movement are attached to it.
- Closure: The incision is meticulously closed with sutures, and the surgeon takes care to ensure that the eye socket appears symmetrical and natural.
- Artificial Eye (Prosthesis): After evisceration surgery, an ocularist, who specializes in creating custom ocular prostheses (artificial eyes), will create an artificial eye to fit the empty eye socket. The artificial eye is designed to match the color and appearance of the remaining eye, providing a natural look.
Evisceration is a significant surgical procedure and is typically considered after all other treatment options have been exhausted. Patients undergoing evisceration require support and counseling to adapt to the changes in their appearance and learn how to care for the artificial eye.
When Do I Get an Artifical Eye (Ocular Prosthesis)?
The timing for receiving an artificial eye (ocular prosthesis) after enucleation or evisceration surgery can vary depending on the individual patient’s circumstances and the specific recommendations of the eye surgeon or ocularist involved in the case. Here are some general guidelines:
- Healing Period: After enucleation or evisceration surgery, there is a healing period during which the eye socket and surgical site need to recover. This period typically lasts several weeks to allow for proper tissue healing and the reduction of swelling and inflammation.
- Custom Fitting: Once the surgical site has sufficiently healed, and the swelling has subsided, an ocularist will conduct a custom fitting for the artificial eye. This fitting involves taking measurements and creating an artificial eye that matches the size, shape, and color of the remaining eye. The timing of this fitting can vary but is often done around 6 to 8 weeks after surgery.
- Artificial Eye Creation: After the custom fitting, it may take a few additional weeks for the ocularist to create the artificial eye to ensure it matches the patient’s appearance as closely as possible. The creation of the artificial eye involves artistic skill to achieve a natural appearance.
- Placement of Artificial Eye: Once the artificial eye is ready, it is placed in the eye socket during a follow-up appointment with the ocularist. They will make any necessary adjustments to ensure a comfortable fit and natural appearance. The timing for this step can vary depending on the ocularist’s schedule and the patient’s healing progress.
- Periodic Adjustments: Over time, periodic adjustments may be needed to maintain the proper fit and appearance of the artificial eye. These adjustments help ensure the eye looks as natural as possible and is comfortable to wear.
- Emotional Support: Emotional and psychological support may be beneficial during the adjustment period. Many individuals find counseling or support groups helpful in adapting to the changes in their appearance.
It’s important to note that the timing for receiving the artificial eye may vary based on individual factors, such as the patient’s overall health, the extent of healing, and the specific practices of the ocularist and surgical team. The ocularist will work closely with the patient to provide guidance on the fitting process and ensure that the artificial eye is customized to their unique appearance.
Overall, the goal of enucleation or evisceration surgery and the use of an artificial eye is to provide you with a natural and comfortable appearance that restores your confidence and quality of life. The ocularist and surgical team will work closely with you to ensure the best possible outcome in terms of appearance and comfort.
Sarah Avila, MD
Specialization: Eyelid Surgery & Aesthetics
Dr. Sarah Avila is an oculofacial plastic surgeon in Miami, Florida. After completing medical school, Dr. Avila completed a residency in ophthalmology at the Mount Sinai Hospital in New York City, followed by a highly competitive two-year ASOPRS-accredited fellowship in reconstructive and cosmetic oculofacial surgery at Emory University in Atlanta, Georgia. During this fellowship, Dr. Avila focused on plastic surgery related to the eyelids, brows, lacrimal duct system, orbit, and face.
