Enucleation of the eye

Enucleation of the eye is a surgical procedure that involves the removal of the eye while leaving the eye muscles and remaining orbital contents intact. This procedure is typically performed to address severe eye injuries, tumors, or infections that cannot be treated with more conservative measures. Enucleation is considered a last resort when other treatments have failed or when the condition threatens the health of the patient or the vision of the other eye.

Indications

Enucleation is indicated in several conditions, including:

• Ocular melanoma: A type of cancer that occurs in the cells that produce pigment in the eyes.
• Severe eye injury: Especially when the injury results in significant pain or loss of vision, and cannot be repaired.
• Endophthalmitis: A severe bacterial infection inside the eye that is unresponsive to treatment.
• Sympathetic ophthalmia: A rare condition where an injury to one eye causes the uninjured eye to lose vision.
• Blind painful eye: When an eye is blind and causes discomfort or pain to the patient.

Procedure

The enucleation procedure involves several steps:

1. The patient is typically placed under general anesthesia.
2. A careful incision is made around the conjunctiva, the mucous membrane that covers the front of the eye and lines the inside of the eyelids.
3. The eye muscles are carefully detached from the eyeball.
4. The optic nerve, which transmits visual information from the eye to the brain, is cut to free the eye from the orbit.
5. The eyeball is gently removed from the eye socket.
6. An orbital implant may be placed in the socket to replace the volume lost with the removal of the eye. This implant is typically made of silicone or porous polyethylene.
7. The eye muscles are attached to the implant to allow for movement of the artificial eye.
8. The conjunctiva is sutured back together.
9. A temporary artificial eye (a conformer) is placed in the socket to maintain its shape during healing. A custom-made prosthetic eye can be fitted several weeks after surgery.

Complications

As with any surgical procedure, enucleation carries risks, including:

• Infection
• Bleeding
• Implant extrusion or migration
• Socket contracture
• Emotional and psychological impact

Recovery

Recovery from enucleation surgery varies among individuals. Pain and discomfort can be managed with medication. The use of a prosthetic eye can help improve cosmetic appearance and may assist in the psychological adjustment to the loss of an eye. Regular follow-up appointments are necessary to monitor the healing process and to fit and adjust the prosthetic eye.

Psychological Impact

The loss of an eye can have a significant emotional and psychological impact. Support from family, friends, and support groups, as well as counseling, can be beneficial for individuals adjusting to this change.

See Also

• Prosthetic eye
• Orbital implant
• Ophthalmology

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