What is enucleation and evisceration?
Enucleation and evisceration are terms that refer to surgery to remove the eye from the eye socket or orbit.
- Enucleation is the surgical removal of the entire eyeball leaving behind the lining of the eyelids and muscles of the eye.
- Evisceration removes only the contents of the eye, leaving the white part of the eye (the sclera) and the eye muscles intact.
Frequently used terms
Following enucleation or evisceration surgery, orbital implants and eye conformers are used to occupy the empty orbit and conform the tissue surrounding the eye to prepare the socket for a prosthesis. The two-part system of orbital implant and ocular prosthesis provides a stable, and well-tolerated aesthetic restoration of the eye socket. Although vision is not restored by a removal of the eye with placement of an orbital implant and ocular prosthesis, a natural appearance can result.
- Orbital implants are marble sized balls placed behind the lining in the socket (conjunctiva) to replace lost tissue volume when your eye is removed. The extraocular muscles can be hooked up to the implant surface to help keep the implant from migrating and to help with socket movement.
- Ocular conformers are designed to be used after surgery to prevent closure or adhesions during the healing process. Conformers are small, acrylic-cup shaped devices whose inner surfaces are shaped to approximately the curvature of the orbit. Use of the conformer makes a significant clinical difference in patients. The conformer will remain in place for 6 to 8 weeks while the eye socket heals and swelling subsides.
- An Ocular Prosthesis (artificial eye) is a type of prosthesis that replaces an absent natural eye following an enucleation, evisceration, or orbital exoneration. The prosthesis replaces the conformer and fits over an orbital implant and under the eyelids.
- An Ocularist is someone who specializes in the fabrication and fitting of ocular prostheses for people who have lost an eye or eye due to trauma or illness.
- An Ophthalmologist is a specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye.
Why is enucleation or evisceration necessary?
Removal of an eye may be required following a severe injury, to remove an intra-ocular tumor (tumors inside the eye), to control pain in a blind eye, to alleviate a severe infection inside the eye, or for cosmetic improvement of a disfigured eye.
Are there any alternative treatments available?
There may be other treatments available and your doctor will have discussed these with you. If you feel that you need further information, please ask your doctor.
What will happen if I choose not to have surgery?
There can be a number of different outcomes if you choose not to have your eye removed. An intraocular tumor may continue to grow or spread to other parts of the body making treatment more difficult. An infected eye may become worse and the infection may spread making treatment and pain management more difficult.
Why choose one procedure over another?
Enucleation is generally the procedure used if the eye is being removed to treat an intraocular tumor, severe infection, or to reduce the risk of developing a severe autoimmune condition (called sympathetic ophthalmia) following trauma to the eye.
Evisceration is a less invasive procedure and may be an option depending on the condition of the eye to be operated on. Your surgeon will advise which surgery is most appropriate for you.
How is the surgery performed?
- Both surgeries are performed in the operating room and usually under general anesthesia but can also be safely performed using local anesthesia with sedation.
- There can be some side effects with both local and general anesthesia including nausea and vomiting.
- A marble size ball implant is placed behind conjunctiva tissue in your socket to replace lost tissue volume when your eye is removed.
- The implant is made out of silicone, plastic, and porous implants such as Medpor (porous polyethylene), hydroxyapatite or bioceramic.
- The implant may be connected to the eye muscles to enable movement of the implant and the artificial eye when it is later fitted.
- A conformer (thin plastic shell) will be placed in the eye socket at the end of the operation to help maintain the shape of the socket and reduce swelling.
- During the operation, you will be given an injection of local anesthesia. This is usually effective in relieving pain for several hours after your operation. After this, any pain is usually well controlled by painkillers.
- The operation takes about one to two hours.
- A pressure bandage is often put on to help with swelling.
- Once healed, your eye socket will look similar to the skin on the inside of your lip. Your tear function will not be affected, and when you have your artificial eye fitted, you will be able to open and close your eyelids as normal.
Preadmission and Day of the surgery
Before your surgery, your doctor will talk through your surgery with you. On the day of your surgery, you should check in on the 4th floor of the Kellogg Eye Center.
For children, the surgery will take place at C.S Mott Children’s Hospital.
On the day of surgery please bring with you:
- Any medications you are taking in their original container
- Personal items you may need such as toiletries
- Name and phone number of primary care physician
- Name and phone number of cardiologist, if applicable
After the surgery?
- You will wake up in the recovery room and have a pressure bandage or pad over your operated eye. After you wake up you will be taken to the Outpatient Surgery Unit.
- You will go home the same day as your surgery.
- Your eye socket will be red and possibly swollen for a couple of weeks.
- You may see colors and other images from the side of the operation (i.e., ‘phantom eye’). This symptom resolves spontaneously.
- The pressure pad will remain on for 6 to 14 days.
- When the pad is removed, eye drops and/or ointment will be used in the socket to aid healing. This continues at home. For some patients, eye drops can be challenging so you may need someone to help you. Make sure you wash your hands before and after using drops.
- For the first 2 to 3 days after surgery you should rest. Movement of your remaining eye will also cause the implant to move and this can cause pain. Avoid bending over as this can cause pressure in the socket and can be painful.
- Your doctor will prescribe a pain-reliever and anti-nausea medication.
- A patch is usually worn over the eye socket until the artificial eye is made.
- You will have a follow-up appointment with your doctor about 4 to 6 weeks after your procedure. This will help detect any complications that would need more treatment.
- After surgery you will be fitted for an artificial eye, known as a prosthesis.
Is it usual to have some sticky or watery discharge from the socket after my surgery?
- A small amount of discharge may occur and accumulate in the inner corner. Larger amounts accumulating or running onto the cheek could be a sign of infection and you should contact your doctor.
- To clean away discharge, use saline solution and a clean cotton ball. Wipe from the outer corner of the eye (near the ear) towards the nose.
- Use each cotton ball only once and then discard it.
- Saline solution can be purchased from a pharmacy.
- Moorfield’s Hospital Videos
- EyeRounds.org (WARNING - Contains surgical images)
- American Society of Ocularists
- The Eye Cancer Foundation
- A Singular View
This page describes the generally accepted practice at the time of publication only. It is only a summary of clinical knowledge regarding this area. The Kellogg Eye Center makes no warranty, express or implied, that the information contained in this document is comprehensive. They accept no responsibility for any consequence arising from inappropriate application of this information.