When a person has a blind eye that is painful, sometimes the only option to relieve the pain may be to remove the eye. The procedures are called enucleation and evisceration and can also be done for cosmetic reasons. Common reasons for blindness in such cases are injury, infection, chronic inflammation, and other diseases.
When the eyeball is removed entirely from the socket, this is called enucleation. A clear membrane that covers the eye, called the conjunctiva, is left in place. Then a prosthetic eye implant is placed into the now-empty eye socket. A thin, glossy, curved painted acrylic disk that looks like the other natural eye is inserted into the implant.
When the inner contents of the eye are removed but not the white of the eye (the sclera) this is called evisceration.
Both procedures are day surgeries that are done at the rocky view Hospital. The procedures take thirty to sixty minutes and may require a local anesthetic, light sedation, or a general anesthetic.
During enucleation, your surgeon will surgically detach the eyeball for the ligaments, muscles, and other tissue that hold it in place. After they remove it, they will insert the implant. This is ball-shaped and may be made of silicone, fat, or coral tissue. The function of the implant is to fill the space left by the eye that was removed and to give support to an artificial eye. The surgeon will reattach the muscles that control eye movement so that the artificial eye will move in the same direction as the other eye.
At the time of enucleation, a conformer is inserted. This is a clear plastic device that goes over the implant and holds the space that the artificial eye will later occupy. The conformer is just a space-holder and not permanent. In fact, it can fall out if the patient pulls their lower lid downward.
After the enucleation procedure, a skilled technician (Ocularist) will make an artificial eye from glass or acrylic that matches the other eye so well that people commonly cannot tell which is the artificial eye.
Fitting for the artificial eye takes place between four and six weeks after the enucleation surgery after your doctor clears you for having the fitting. Unlike the conformer, the artificial eye is meant to stay in the eye and will not fall out easily. You will be followed over the years by both Orbit Eye Centre and the ocularist.
The evisceration procedure is different from enucleation in that the white of the eye is retained and the eye muscles and ligaments are not detached The prosthesis is inserted inside the sclera of the eye and, as with enucleation, the patient gets an artificial eye after being OK’d for the fitting several weeks after the surgery.
Immediately after surgery, you can expect to have an IV giving you fluids and perhaps antibiotics as well. This will be for several hours to as long as a day. There will be a large and quite snug gauze dressing over the eye that had the surgery and this needs to stay in place for several days. Even after the gauze comes off the eye socket area will be bruised and swollen. This will subside over the next three weeks or less.
Pain and some nausea are common after both enucleation and evisceration. You will receive medications as needed. Be sure to contact our office if the medications are not sufficient. Because enucleations are usually done for pain, patients commonly report that they are much happier and comfortable with their pain gone.
You will feel drowsy as the anesthetic wears off. This may take several hours. That is why you will stay at the hospital under nursing supervision and why a nurse will be with you when you first get up to move around.
If the enucleation or evisceration was done entirely for pain and the affected eye still had some vision, you will recognize that your field is vision is less and that your depth perception is gone. People adjust over time to these changes and the ocularist has several useful resources to help you.
After the surgery we will recommend that you first apply ice packs and later warm compresses for swelling, bruising, and bleeding. This will be for about three weeks during which time you will get better and better. As you are healing, make it a point to keep your head up as much as possible.
Because the sutures within the eye socket dissolve by themselves, you will not need to have sutures removed.
When you go home make sure your dressing stays dry and clean. Taking a tub bath instead of a show is a good idea. The dressing will be removed at two to three days after surgery in our office.
However, you will wear a patch over the eye that had the surgery for up to a week after surgery. You will change the patch daily until the discharge subsides. You will receive an ointment to apply to the eye socket to keep it moist. Be sure to wash your hands with soap and water every time before touching the patch or the area around the eye. By a week after surgery, you can forget about the patch if you wish.
The conformer is meant to stay in, and you should not remove it unless told to do it. If it falls out, just wash it with warm, soapy water and then rinse with boiled, cooled water. Once it is cool you can reinsert it. If you are unable, just contact Orbit Eye Centre or the ocularist.
Avoid all strenuous activity for at least two weeks after your surgery and then increase your activity gradually and never so much as to feel uncomfortable.
If you were already blind in the eye that was removed, you may have already been following precautions to protect your good eye. Wear shatter-resistant glasses at all times and avoid the sort of activities like contact sports that could endanger your good eye.
If you have any questions after your eye surgery always feel free to contact the clinic. However, there are specific reasons why your surgeon will want you to contact him immediately.
If any of these occur and persist and you are unable to contact Orbit Eye Centre, go directly to the Rocky view Hospital emergency department, day or night.
The surgical coordinator will set up your follow up appointments in the office when the surgery is scheduled. If the surgeon needs to see you before your scheduled time, we will call you to inform you of the date and time for your early appointment.
Dr. Karim Punja, an Ophthalmologist at the Calgary Orbit Eye Centre, specializes in oculoplastic surgery and cosmetic and reconstructive eyelid surgery. He has extensive experience in blepharoplasty (droopy eyelids), Botox & fillers, lacrimal & orbital surgery, and cataract surgery.
Dr. Chirag Shah is a comprehensive Ophthalmologist in Calgary and retinal medical specialist. His practice areas focus on retinal diseases, including age-related macular degeneration (AMD), retinal detachments, retinopathy of prematurity (blinding retinal disease in premature babies), diabetic retinopathy, hereditary eye diseases, and hypertensive retinopathy.
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