Surgical Risks Little Rock
Side Effects / Complications of Enucleation or Evisceration surgery
- When an eye is removed, the patient loses all vision and the cosmetic use of the globe. Reported complications include hemorrhage, infection and extrusion of the implant.
- Most patients with post-operative hemorrhage are either on blood thinners (e.g coumadin, plavix, heparin or aspirin) or are known to have a bleeding disorder. Such hemorrhages can be painful, but intervention is rarely helpful. Patients are typically treated with analgesic medications (pain-killers).
- Orbital Infections are very rare, but are more common with integrated orbital implants. Most secondary orbital infections can be managed with antibiotics, covering or surgical removal of the orbital implant.
- Implant extrusions can be managed by surgical replacement of the orbital implantNormal Volumes of the Orbit
- Adult orbital volume ranges from 24 to 30 ml
- Female orbital volume is approximately 2 mm less than male adults
- Each orbit contains approximately 10 ml of fat; extraocular muscles account for 5 ml of volume and the normal eyeball accounts for approximately 7 ml.
- This involves enophthalmos, a deep upper eyelid sulcus, lower eyelid laxity with shallow fornix with possibly Ptosis or lid retraction.
- When an eye is removed, recall there is a 7 ml volume loss; however, the most commonly used 18 ml sphere replaces a volume of approximately 3 mm while a 16 mm sphere replaces a volume of 2 ml. A 20 mm sphere provides 4.1 ml of volume.
- The situation is made worse by orbital fat atrophy of up to 3 ml.
- It is unclear whether fat atrophy recurs as a result of reduction of blood supply or due to mechanical manipulation during surgical enucleation.
- Bony orbital volumes are also noted to be smaller in patients who have had long-standing enophthalmia.
Exposed Orbital Implant
is the result of the following:Post-enucleation anophthalmic socket
- Loss of volume
- Structural changes
- Fat atrophy
- Retraction or changes in extraocular muscles
- Loss of support of the levator complex
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Little Rock, Arkansas 72205