Blind Eye Removal

For a blind eye that is painful or disfigured,ย or an eye with a malignant tumour

Removal of an eyeball is known as Enucleation, and removal of the contents of the eyeball (leaving the outer coat of the eye attached to the eye socket muscles), is called Evisceration.

These operations are only undertaken when all other eye treatments are ineffective, inappropriate or undesirable. It is the final measure taken by your ophthalmic surgeon and is generally carried out when a patient has suffered a severe trauma, particularly where the eyeball has been ruptured and it’s unlikely that sight will be recovered.

Rarely the good eye can become inflamed after the affected eye is damaged, called sympathetic ophthalmia. Early removal of the damaged eye may prevent the risk of inflammatory damage of the good eye.

Enucleation is recommended if a large cancer involves the eye, and it cannot be removed or destroyed or where treating the cancer leaves the patient with little or no sight and a permanently painful eye.

Occasionally after failed retinal detachment surgery or ocular injury, the blind eye can shrink (phthsis bulbi) or look disfigured or can become extremely painful. In such cases, an enucleation or evisceration can help in pain relief and allow your surgeon to rehabilitate the eye socket.

Rarely the entire eye may get a severe infection, which does not respond to antibiotic treatment, and an evisceration may be a last ditch option to gain control of the infection.

Orbital Implants are usually used to replace either the entire eye or to fill an eviscerated eye. Think of the normal eyeball as an inflated balloon, once the eye had been enucleated or eviscerated, it looks like a deflated balloon and requires an implant to be placed in the coats of the eyeball or eye socket to restore volume. Rarely, when there is severe shortage of lining and volume a dermis fat graft is recommended (harvested from your buttock or abdomen).

Four to six weeks after surgery, a prosthetic or artificial eye (which looks like a big contact lens), is placed over the implant. When the muscles of the eye socket move, the artificial eye moves too.

blind-eye-removal-header

Treatment for Blind Eye Removal

The procedure is performed in an operating theatre as day surgery under general anesthetic.

The procedure takes approximately 60-90 minutes. The contents or entire eyeball is removed and tissues are closed over it.

A temporary clear plastic shell (conformer) is fitted on top of the implant for a month after surgery to prevent the socket shrinking and give some shape while the socket heals.

blind-eye-removal-diagram

The eye is padded shut for the first 48 hrs and on removal, when you open your lids, you will see the moist pink lining of the socket (like the inside of your mouth). The conformer will look like a clear plastic shell with a hole in the centre, which allows for instillation of the eyedrops. This conformer will stay in place until you are fitted with an artificial eye in 4-6 weeks. During this period the pink colour of the lining will change to white.

The ocular prosthetist will create a detailed artificial eye to match the natural eye, this process can take up to a few days or weeks to perfect.

What are the potential risks & complication of Enucleation/ Evisceration?

After Enucleation or Evisceration, there is a tendency of the lining of the eye socket (conjunctiva) to shrink over time. This can be controlled/ reduced to a significant extent by wearing an artificial eye constantly. In addition, the tissues of the eye socket can undergo shrinkage, causing the upper and lower lid sulcus/fold to look deep and hollow (called post enucleation socket syndrome)

Although wearing a larger prosthesis can reduce this appearance, the associated increase in weight can cause the lower lid to sag (ectropion). This can also present as instability of the prosthesis (falls out easily) or drooping of the eyelid (ptosis). As a result a few patients ask for additional surgery to improve the aesthetic appearance by either, correcting the ptosis, tightening the lower lid or improving the volume (removal of old implant & insertion of larger implant, placement of a orbital floor implant or injection of fillers). Your surgeon will discuss the best options for you.

The artificial eye or prosthesis has certain inherent issues related to movement, never achieving full range of movement as a normal eye. Range of movement can be improved by pegging or by reducing the size of the artificial eye at the inner & outer corners.

Some patients develop an allergic response to the artificial eye, causing chronic discharge, which can be avoided by annual ultrasonic cleaning of the prosthesis.