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EviscerAtion OF eye

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Eye removal surgery may be needed in cases of a painful blind eye, eye cancer or following a severe injury or infection of the eye.

There are two main types of eye removal surgery:

1. Enucleation. The entire eye (globe) is removed in an enucleation. The muscles that control eye movement are left intact and are resewn to the spherical implant (artificial eyeball).

2. Evisceration. During an evisceration, the cornea (clear, dome-shaped window at the front of the eye) and the contents of the eye are removed. The white part of the eye (the scleral shell) and the eye muscles are left intact. The implant is then placed into the scleral shell to which the muscles are still attached.

Of the two procedures, evisceration generally takes less time and is less invasive. However, not every patient is the right candidate for evisceration. With cancer, trauma (serious injury) and infection of the eye, enucleation is usually preferred over evisceration. In other cases, either procedure can generally achieve the same result.

A painful, blind eye before surgery. (Photo courtesy of Rona Silkiss, MD)

Talk with your ophthalmologist to determine which is the best surgery for you and whether there are any specific risks that you might need to consider when deciding which procedure to have.

It’s important to note that with either surgery, the results are not alterable and irreversible—there is no way to regain vision in that eye.

What to expect when you have eye removal surgery

Before the surgery. Tell your ophthalmologist about all the medicines you take. Your surgeon will tell you if you can keep taking them before surgery. Usually all medicines except blood thinners should be continued. The timing for discontinuation of a blood thinner is dependent on the type of blood thinner and its half life (metabolism of the drug in your system) as well as the health reasons you were placed on the medication.

When choosing a date for the surgery, keep in mind that strenuous physical activity and swimming are not advised for two weeks after surgery. It also may take up to two months of healing before you can be fitted for a prosthesis. The prosthesis is like a large contact lens, custom painted by the ocularist to resemble your other eye. It fits over the implant placed inside the eye during surgery. You should choose an ocularist and schedule an appointment with them before the surgery.

The day of your surgery

Here is what will happen just before and during eye removal surgery:

• Both procedures take place in the operating room and you will be given either general anesthesia (numbing medicine and medicine that puts you to sleep) or local anesthesia with sedation (numbing medicine and medication that helps you relax).

• As part of the eye surgery, a marble-like implant is placed inside the eye to fill the empty socket.

• With enucleation, the six extraocular eye muscles are sewn to the implant. With evisceration, the muscles maintain their connection to the sclera so there is no need for surgery on them.

• A temporary plastic prosthetic called a conformer is placed over the implant. The conformer aids healing and serves as a placeholder between the eyelids and the orbital implant, where the custom-painted final prosthetic will sit six to eight weeks later.

• Sometimes, the eyelid is sewn shut to help the wound heal and hold the conformer in place.

• A large pressure bandage or dressing is taped over the eye to protect the wound and prevent bleeding. It also helps reduce inflammation (swelling, soreness, and bruising).

• Generally, both surgeries take about an hour. In most cases, the surgery is outpatient, meaning you can go home the same day.

Implants placed in the eye during eye removal surgery. (Photo courtesy of Rona Silkiss, MD)

The temporary contact lens–like prosthetic placed over the implant pictured above. (Photo courtesy of Rona Silkiss, MD)

After surgery

Ride home. Arrange for a ride home from the hospital. You are not allowed to drive yourself home because driving yourself can be dangerous after receiving anesthesia. You also must be taken home by an adult other than a ride sharing service unless they have special qualifications.

Pain/medication. You may receive medication for pain, but over-the-counter pain relievers are enough for most patients. Prescription antibiotics or steroids may be needed in some cases.

Restrictions. Swimming, strenuous exercise or other demanding physical activities are restricted for two to four weeks. Bending at the waist and lifting heaving objects should also be avoided for up to a month. You may drive and perform other normal activities as soon as you feel well enough. Ask your surgeon for specific recommendations.

Take care to keep the bandage that is covering the eye dry. At times the bandage may feel itchy or uncomfortable, but it's important to keep it on as long as your surgeon says to. Generally, the bandage can be removed the next day.

Follow-up. The follow-up exam takes place about a week after the surgery. At this time, your surgeon may remove the bandage if you have not already done so, and look at your eye to see how it's healing.

Prosthetic. Once your surgeon finds your eye to be fully healed, you can be fitted for your custom prosthetic by your ocularist. Most patients are ready for their prosthetic six to eight weeks after surgery.

Your prosthesis can last decades if properly cleaned and maintained. You should have follow-up visits with your ocularist and surgeon one to two times per year. They will check the health of your eye socket and clean and polish your prosthetic. If you feel comfortable doing so, you can remove your prosthetic and clean it yourself between visits with your ocularist and surgeon.

Possible problems with eye removal surgery

Some problems resulting from eye removal surgery can include:

• Bleeding

• Infection

• Scarring

• Eyelid droopiness or difficulty closing your eye

• Implant falling out (extrusion)

Talk with your surgeon to discuss the risks and benefits of surgery for you.

In general, eye removal surgery is performed to enhance a person's life. It is used to treat life threatening tumors or relieve patients of a blind, painful eye. The decision to remove an eye may be amongst the most difficult you need to make in your life. It is hoped, however, that the relief from pain and illness will be life enhancing and allow you to live your life fully and completely.