Enucleation

Enucleation is the surgical removal of the entire eye. This operation may be required following a severe eye injury, to control pain in a blind eye or to treat eye cancer.

Surgery

During the surgery the eye is removed and an implant is placed in the eye socket. The implant is made up of hydroxyapatite (it is a mineral that is a component of bone and tooth enamel). The implant has many pores which allows blood vessels to integrate with the implant. As seen in the picture below, the implant has pre-made holes that allows the muscles to be sutured to the implant. Integration of the 4 eye muscles allows for some movement of the eye along with movements of the other eye.

After surgery

• We recommend that we admit the patient for 1 day after surgery mainly for pain and nausea control
• After surgery a heavy patch is placed over the eye and the patch is left in place for 2-4 days
• When the patch is removed the tissues would look red and there will be a clear conformer that needs to stay in place for 6-8 weeks until the final prosthesis is fitted
• An ointment would be prescribed and the ointment needs to be used 3 times a day for 1 month or until the prosthesis is filled.
• The pain after surgery is controlled with over the counter pain medications.
• We may also prescribe medications to control nausea and vomiting.

Care after surgery

• The patient does not have to wear a patch after the first 3-4 days. You can wear a patch until you receive your prosthesis if that would make you more comfortable. You can also wear sunglasses instead.

• The conformer could fall out after the surgery. If you feel comfortable replacing the conformer, clean the conformer with soap and water and put it back between your eyelids, like a contact lens. If you don’t feel comfortable replacing it, call your doctor and they can help put it back. The conformer needs to stay in until the prosthesis is fitted.
• Mucous drainage is normal after surgery. You can clean the mucous from the eyelids by using a clean wash cloth soaked in warm clean water.
• We recommend no swimming and no baths till the prosthesis is fitted. Showers are good.
• We recommend wearing polycarbonate shatter proof glasses to protect the other eye from any injury for the rest of the patients life.

What are the risks?

The operation is performed under general anesthesia. There are risks associated with any operation. There are small risks associated with general anesthesia.

The main risks of this operation include bleeding, infection, inflammation, lid swelling, dropping of the eyelid and breakdown of the wound. Longer-term risks include discharge from the socket, socket irritation and exposure of the ball implant. These complications are rare.

Ocular prosthesis

The artificial eye, or ocular prosthesis, is fitted usually 6-10 weeks after surgery. The designing and fitting of the prosthesis is done by an ocularist and your doctor will send the referral to the ocularist after surgery.

Adjusting to a prosthetic eye

Losing an eye and being fitted with prosthetic eye can be an emotionally traumatic experience for the patient and the family and it requires a significant psychological (as well as physical) healing period. Please ask your doctor for any assistance and they can also direct you to a support group that can help with the coping during the adjustment period. 

Resources

Please find attached a handout about the surgery. Also please find below some resources.

• A Different Perspective - Your Guide to Eye Loss & Recovery
• Order ELLI and find a new friend
• The Extraordinary Eye book