Enucleation
Enucleation refers to the removal of an eye. The muscles which move the eye (the extraocular muscles) are detached from the eye and the optic nerve is severed enabling the eye to be removed from the orbit (the eye socket). The whole eye is removed in contrast to an evisceration. An evisceration refers to removal of the cornea (the usually clear window at the front of the eye) and the contents of the eye, leaving the sclera (the white of the eye) and the extraocular muscles intact.
The removal of an eye and the subsequent management of the anophthalmic socket still pose a considerable challenge for the ophthalmic surgeon in spite of many recent advances in orbital implant materials. Good results from such surgery are not easy to achieve consistently and a poor result can have profound psychological implications for the patient for the rest of his/her life. It is for this reason that such surgery is undertaken at Manchester Royal Eye Hospital by specialist oculoplastic surgeons who are very skilled and experienced in such procedures. The preoperative counseling of a patient who requires an enucleation demands time and considerable compassion on the part of the ophthalmic surgeon. Close collaboration between the ophthalmic surgeon and the ocularist (the skilled technician who makes and fits the artificial eye) is essential and should commence preoperatively whenever possible.
The goals of an enucleation or an evisceration are to achieve the following:
- A healthy and comfortable socket free of discharge which can be fitted with a stable ocular prosthesis (artificial eye) that mimics the fellow eye in appearance and movement as much as possible
- A symmetric result without a sunken appearance or an upper eyelid hollow
- An absence of any drooping of the upper or lower eyelids
- Normal eyelid closure over the ocular prosthesis
To achieve these goals, the enucleation must be approached in the same manner as any intraocular procedure and must be performed meticulously.
Indications for enucleation
There are a number of indications for enucleation:
- A blind painful eye
- A blind unsightly eye
- An intraocular tumour, e.g. a large choroidal melanoma
- Severe irreparable ocular trauma and a high risk of sympathetic ophthalmitis affecting the fellow eye
It is important to consider alternatives to enucleation wherever possible. The movement of a blind (or partially sighted) eye, or of a microphthalmic or phthisical eye (small underdeveloped or shrunken eye) can be more natural than that of an artificial eye following an enucleation and placement of an orbital implant and such an eye may tolerate the fitting of a cosmetic shell or cosmetic contact lens.
Enucleation with an orbital implant
Most patients undergoing an enucleation receive an orbital implant. The most appropriate implant for the patient is selected.
Click here for more info on Socket Reconstructive Surgery and orbital implants page.
Consultants who undertake this procedure:
Saj Ataullah
Anne Cook
Brian Leatherbarrow
Ahmed Sadiq |
