Enucleation and Evisceration Surgery

Enucleation and evisceration are two procedures used to remove an eye. The healing process is also almost the same for both procedures. You will have an implant put in the eye socket at surgery to help replace most of the eye. You will have an artificial eye (prosthesis) made by an ocularist about eight weeks after the eye is removed.

With enucleation, the whole eye is removed, and the eye muscles are reattached to the implant.

In evisceration, the clear front part of the eye (cornea) and the contents are removed, but the tough white coat of the eye (sclera) is kept. An orbital implant (Figure 1) is placed in the socket to replace most of the eye.

Figure 1. Silicone and porous orbital implants

During Surgery

You will be under general anesthesia or deep sedation.

In either surgery, the soft tissue layers are then closed. A plastic shell, or conformer (Figure 2), is placed behind the eyelids, and the eyelids are often stitched together for a short time.

Figure 2. Plastic conformer

Pain

Pain varies by patient. You will take pain medicines to help control pain. Resting, icing, and avoiding strenuous activity that could increase pressure in the socket will help. The first 2 days are often the toughest but will slowly get better over the next week. If the pain becomes worse, or causes a lot of nausea or vomiting, contact the office or doctor on call to ask if you need to be seen.

Care of the Socket

You will have a large dressing for 3-4 days after surgery.

The taped dressing (Figure 3) may get pink or red from light bleeding in the first few days but should not be removed or changed.

Figure 3. Postoperative pressure dressing

This bandage keeps pressure on the socket to keep down swelling and bleeding. You do not need ointment while the pressure dressing is in place. The eyelids will be sewn shut for a short time (Figure 4). These sutures will be removed at your next visit.

Figure 4. Eyelids may be sewn closed.

Once the bandage has been taken off (the 4th morning after eye is removed) the lid tissues may be cleaned gently with warm, wet compresses to remove dried blood and crusting.

Starting the Eye Ointment

We will place ointment in the socket at the end of surgery. You do not need to re- apply it until the dressing is removed. After the bandage has been removed, you can place a small strip of ointment on the eyelashes with a clean finger or Q-Tip, 2-3 times a day.

The Eye Socket After Surgery

At first, the socket will be swollen and bruised. As the socket heals, the tissues will become less swollen and red, and the sutures dissolve on their own. The round implant helps fill up the socket so that it does not look like a cavity or hole.

If the lid is lifted, the socket will be a fairly even pink tissue all over (Figure 5). You may cover the socket with gauze if you wish, but this is not required. Some patients choose to buy and wear a black eye patch until their prosthesis is made. The upper lid may also be droopy until the final prosthesis is made.

Figure 5. Healthy pink socket after surgery

Activities

Avoid strenuous activity for one week after surgery or until you see your doctor. This includes bending, exercising, sports, and lifting more than 15 pounds. Any activity that increases your heart rate a lot soon after surgery may cause bleeding or increased swelling in the socket. This may slow healing or risk the final outcome.

Care for the Clear Conformer if it Falls Out

The clear conformer (Figure 2) placed at the time of surgery is not custom fit to your socket. It may fall out after surgery if you pull down on the lower lid. If the conformer falls out, it should be:

1. Gently cleaned with regular soap and water only. Do not use cleaning chemicals or alcohol swabs.

2. Hold the conformer, which is a clear oval disk, sideways.

3. Place the conformer gently under the upper lid until it stops.

4. Hold it in place and use your other hand to pull the lower lid edge down and over the bottom edge of the conformer. Once the lower lid lashes come around the bottom of the conformer, it will fit back in the socket.
   

If you cannot replace the conformer back in the socket, it can be left out. Please call the doctor’s office during clinic hours to see if you need to schedule a visit. This is not an emergency.

Fitted for the Artificial Eye and How it is Done

The prosthesis (Figure 6) is fitted about eight weeks after the eye is removed to allow swelling to go down. You should schedule the visits with your ocularist’s office before your surgery. An ocularist is a medical artist trained in fitting and making ocular (eye) prosthetics. Three visits for fitting your new eye are often scheduled two days in a row. During these visits, the prosthesis will be molded and painted to best match the other eye.

Figure 6. Custom made ocular prosthesis (front and back views)

How The Prosthesis Fits in the Socket

Because the prosthesis is custom made for your socket it should fit without any adhesives or other devices. It simply goes behind the upper and lower eyelids like a large thick contact lens. The ocularist may often mark the top of the prosthesis to help you when putting it in the socket.

Care of the Prosthesis

If the prosthetic eye fits well and is comfortable, it is better to leave it in and not take it out every day. It does not need to be cleaned daily. If needed, use warm water and gentle soap or baby shampoo. Please ask your ocularist about caring for the eye. This eye will need to be replaced every 5 to 8 years, and more often for children. Your ocularist will also need to clean and polish it every 6 months to a year.

Will I be able to drive again?

Most patients, who have lost sight in one eye and have good vision in the other eye, will be able to drive in the future. Driving shorter distances and during the daytime will be a good start. Those who have lost an eye cannot get a commercial driver’s license.

For More Information

A Singular View: The Art of Seeing with One Eye (Paperback) by Frank B. Brady

Who to Call

If you have more questions, please call:
Ophthalmology Clinic
(608) 263-7171
Rockford Clinic
(815) 399-1141