Evisceration / Enucleation

Evisceration / Enucleation
(Partial or Full Eye Removal)

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EVISCERATION/ENUCLEATION
(Removal of Part or the Entire Eye)

WHAT CAUSES THE NEED FOR EYE REMOVAL?

Because of trauma or disease such as diabetes or malignant tumor that leads to blindness and pain (phthisis), it is sometimes necessary to remove part/the inside of the eye tissues (evisceration) or all / the entire eye including the white part (enucleation) of the eye. Most blind eyes do NOT need to be removed if they are not painful or if they have no malignant tumor. If a malignant tumor such as a retinoblastoma or melanoma is found in the eye, enucleation may be required. If an eye has become very painful with no useful vision from trauma or multiple intraocular surgeries, part of the eye may need to be removed by evisceration to stop the pain.

HOW IS THE SURGERY PERFORMED?

During an enucleation or evisceration, the patient is typically placed under heavy IV sedation or general anesthesia (completely asleep) and the entire eyeball (the globe) is removed. Usually, an implant is placed in the socket under the soft tissues and attached to the eye muscles to fill up the space left from the removed eye. With an evisceration, the white part of the eye (sclera) with its attached muscles is left alone. Only the inside degenerated part is removed. The implant is then placed inside the sclera and closed up under the soft tissue. The goal of surgery is to eliminate the tumor or pain and leave the patient with a good cosmetic outcome.

HOW WILL THIS SURGERY AFFECT MY ACTIVITIES AND MY APPEARANCE?

In most cases, the removal of a damaged and scarred eye will improve the cosmetic appearance but these judgments are always subjective (beauty is in the eye of the beholder). Usually the side that has had surgery does look a little more sunken then the normal side. The prosthesis is made about 2 months after surgery by an ocularist (not by your surgeon). However, movement of the prosthesis will not be completely normal and the prosthesis may move quite a bit or not at all. Because most patients having this surgery are already blind in the eye to be removed, their daily activities change little if at all.

WHAT ARE THE MAJOR RISKS OF THIS SURGERY?

Risks of eye removal include (but are not limited to) bleeding, infection, scarring and the complete and total loss of the eye contents forever. In addition, there can be problems with the implant that may require additional surgery to correct but this is uncommon.

WHAT ARE THE ALTERNATIVES?

You may simply decide to live with the pain and associated problems that a blind and painful eye can cause. However, if you have a tumor in the eye, you may require other procedures such as chemotherapy or radiation to deal with the malignancy.

WHAT TYPE OF ANESTHESIA IS USED? WHAT ARE ITS MAJOR RISKS?

Eye removal can be performed under sedation with local anesthesia (injections around the eye) or under general anesthesia. Risks of anesthesia include but are not limited to damage to the surrounding tissues and structures, breathing problems, and, in extremely rare circumstances, stroke or death.

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