Removal of an entire eye is enucleation and removal of the contents of the eye is evisceration. In evisceration, the white part of the eye is spared, keeping the muscles intact. Enucleation or evisceration may be necessary if there’s an injury in the eye, and it is done to alleviate infection, to control the pain, also for treating some intraocular tumours, or cosmetic enhancement of a mutilated eye.
How is the surgery performed?
Both surgeries are usually performed in the operating room under general anesthesia, although they can be completed safely using local anesthesia with sedation. After enucleation or evisceration, most of the lost volume is replaced by an implant placed in the eye socket. The implant is a usually a sphere made of silicone rubber, polyethylene, hydroxyapatite, or alumina, and is covered by the patient’s own tissue.
In most cases, the eye muscles are attached to the implant following enucleation, in order to preserve eye movement. Several weeks after surgery, an artificial eye, or prosthesis, is made by an ocularist. The front surface of the artificial eye is custom painted to match the patient’s other eye. The back surface is custom molded to fit exactly in the eye socket for maximum comfort and movement.
The prosthesis is easily removable, and may be removed as needed for cleaning. Most patients sleep with the prosthesis in place. A prosthesis lasts decades in many patients. Some surgeons may offer the option of placement of a motility peg. This peg is inserted into the implanted sphere, usually several months after surgery.
The front of the peg fits into a small concavity on the back surface of the prosthesis. This fixes the implant directly to the prosthesis to try to achieve better movement. This procedure is associated with potential complications, and should be discussed with your surgeon.
What is the post-operative care?
Some patients spend the night at the hospital, while others go home the same day as surgery. You may be asked to take medications after surgery such as antibiotics, steroids, or pain-relievers. Patients may wear a patch after surgery for several days to several weeks, until they receive their prosthesis.
Continued follow-up is important as the tissues in the socket may atrophy (shrink) with time. This loss of volume may lead to eyelid laxity or socket changes that may affect the fit of the prosthesis. Careful monitoring of the socket and prosthesis by the surgeon and the ocularist will help keep the socket healthy, and will allow for early detection of any changes that may require further treatment.