Enucleation and Evisceration Little Rock
Loss of an Eye
Because of injury or disease it will sometimes be recommended to patients to have their eye removed. The three most common reasons or combination of reasons for the eye to be removed are when it is chronically painful despite medical management, the eye is blind (perceiving only light or no light at all), and/or the eye is severely disorganized, small, or draws a significant amount of attention than the other eye.
Removing an eye can be a difficult decision for the patient. It is natural to want to keep one’s eye as long as possible. However, the goal of removing the eye is to restore comfort and a sense of wholeness to the patient. A typical response from patients who have had a blind, painful eye for several years and had surgery after surgery to try to preserve the eye, is that they only wish they had removed the eye sooner. They were able to focus more on the people and events in their lives rather than the pain from their eye and the distractions that come with multiple surgeries and physician visits. For patients who lose an eye suddenly or lose their vision suddenly from an injury, removal of the eye can be a frightening proposition. When an eye has no known potential for vision because an injury has made the eye very disorganized, and the best efforts have been made to repair the eye, it is frequently recommended that the patient have the eye removed. If the eye is removed in a period of 10-14 days after the injury, it is unlikely that the immune system will ever attack the “good eye.” However, if the injured eye is left in place more than 10-14 days, there is a very remote possibility that in the patient’s lifetime the immune system may turn against the “good eye.” This condition is called sympathetic ophthalmia.
Even for the most stalwart patients it is normal to feel blue or depressed following an injury to the eye that results in sudden blindness or loss of the eye. Dr. Brock wants you to know that this is a normal response and he urges you to treat this medically with the assistance of your primary care physician or other qualified specialist. Once it has been recommended that your eye be removed, Dr. Brock and his staff are here to educate you and assist you in making the best decision possible to improve your quality of life and future.
There are basically 2 approaches for removal of the eye; enucleation or evisceration.
Unlike many oculoplastic surgeons who may perform only one or the other of these surgeries, Dr. Brock has a significant amount of experience in both approaches and chooses the approach based on the indications and advantages for each individual.
Enucleation means that the entire eyeball is removed. The eye is detached from the muscles that move the eye and from the optic nerve. The muscles and soft tissue of the eye socket are left in place. An orbital implant is placed in order to replace the lost volume from removal of the eye. When you hear Dr. Brock refer to the implant, he is not referring to the prosthesis which you will receive later. The orbital implant is a sphere that is placed at the time of surgery to replace the volume loss from removing the eye.
Enucleation is recommended when there is a suspected malignancy or cancer within the eye, the eye has been acutely injured and needs to be removed to avoid the possibility of future sympathetic ophthalmia, or when the eye is very phthisical and shrunken. Enucleation is the most commonl surgery to remove the eye following an acute trauma.
Evisceration is performed by removing the contents of the eye but leaving the wall of the eye, or sclera, attached to the extraocular muscles. This can be performed when there is ample sclera available and when there is no suspicion or concern of a malignancy or cancer. Evisceration is performed more commonly for patients who have lost their vision due to chronic disease rather than acute trauma.
Dr. Brock places an orbital implant behind the sclera of the eye after disconnecting the optic nerve from the back of the eye.
When an evisceration is indicated and can be performed, it does have some advantages over an enucleation. With an evisceration more volume is left in the eye socket because you are not removing the wall of the eye. In addition, the orbital implant has thicker tissue over it, so it is less likely to become exposed or extrude. In addition, because the muscles of the eye remain attached to the sclera over the implant, there is slightly more preservation of eye movement.
In the case of an enucleation or evisceration, a clear conformer is placed behind the eyelids until a prosthesis can be made by an ocularist. The prosthesis is the “artificial eye. This is usually constructed anywhere from 4 to 8 weeks postoperatively, depending on the progress of the patient’s healing. The eye is usually kept closed with a suture and pressure dressing for the first 1-2 weeks following surgery.
Because of Dr. Brock’s training and experience, he is considered by many to be the best oculoplastic surgeon to select when performing these procedures.