Enucleation (Eye Removal)
The need for eye removal has been documented in the oldest written "Code of Hammurabi" of Babylon (1958-1916 B.C.) Since that time, the concepts of when and how to remove eyes have undergone a significant evolution. However, the goals have always remained the same; to remove the offending eye, protect the remaining eye, provide facial symmetry and allow movement of the ocular prosthesis (false eye).
Eye removal may be necessary due to ocular pain, glaucoma, trauma, globe shrinkage, infections, inflammation or tumors. There are two types of eye removal; enucleation where the entire eye is removed and evisceration where the inner contents are removed leaving the "white" of the eye intact. The main advantage of enucleation is to completely remove the eye contents, particularly when tumor is a consideration. The advantage of evisceration is to preserve movement since the eye muscles remain at their natural attachments to the sclera (white of the eye.) In addition, evisceration allows a more normal anterior position of the implant.
When an eye is removed, the volume of the globe must be replaced or the remaining socket will appear "sunken." A spherical implant is typically buried in the socket. the appearance of a normal eye is created by the false eye, which is worn behind the eyelids like a large contact lens, to fill the remaining volume. For more information about ocular prosthetics see the following websites:
American Society of Ocularists Eye ConcernHistorically, implant materials have included everything you can imagine, with a variety of success. Most recent implants seek to maximize movement of the false eye through integration of the buried implant with the plastic false eye. The major integrated implants used today include a "coral" or hydroxyapatite implant and a "plastic," implant. These materials are porous which allows tissue to grow around and within making it a "living" implant. This offers two major advantages; the ability to "heal" itself and the opportunity to use a pinning device to connect the buried implant with the plastic false eye.
The removal of an eye can be painful in the early post-operative period depending upon the exact procedure performed and your pain tolerance. In order to control pain, you will be admitted to the hospital and given appropriate pain medications. The latest pain medications include a sustained release tablet to evenly distribute the medication over twelve hours. This reduces dosing intervals and side effects. Additionally, a technique to stop pain at its source utilizes an infusion of local anesthetic directly into the eye socket. The sole purpose for hospitalization is for pain control. when comfort is maintained on oral medications alone, you will be allowed to return home. Most people stay between one and three days for pain control.
The false eye (ocular prosthesis) is created after the socket has fully healed (usually five weeks.) An Ocularits is a board certified artist and a technician who makes ocular and orbital prostheses. After a custom impression fitting of your socket, the prosthesis will be adjusted, painted and polished to match your existing eye.
* All procedure photos are Dr E’s patients pictured before and approximately five weeks after surgery