EVISCERATION AND ENUCLEATION
Enucleation is the removal of the eyeball with preservation of the orbital contents: muscles, eyelids, lacrimal gland. Evisceration involves the removal of the ocular contents, preserving the outer layers of the eye, in order to place an implant to replace the ocular volume.
When are these surgeries performed?
The reasons that lead to enucleation and evisceration range from severe trauma where it is impossible to reconstruct the eyeball, which is an increasingly rare cause, to eyes that have become blind and painful, blind and severely disfigured eyeballs, and tumors that grow inside the eye and are not treatable.
What does the surgery consist of?
In enucleation, the eyeball is removed but the muscles that move the eye and the rest of the orbital contents are preserved. During evisceration, only the eye contents are removed, preserving the sclera or white part of the eye, the conjunctiva, the muscles that move the eye and all the other orbital contents. An orbital implant is then fitted to replace the removed volume. This is usually a sphere that is inserted into the muscle cone in enucleation, or into the sclera in cases of evisceration. In this way, the muscles can make the implant move. Once the operation is completed, the conjunctiva is closed over this implant and a clear acrylic lens called a “conformer” is placed. This lens ensures that the healing process can be monitored until it is complete.
What are the postoperative period and the making of the prosthesis like?
Once the healing is complete, a process which usually takes one month, the prosthesis is made. The prosthesis is an acrylic lens, custom-made by a specialized prosthetist, who aims for maximum symmetry with the other eye. This prosthesis usually moves very well, but rarely as well as the other eye.
Do I have to remove the prosthesis every day?
Thanks to modern fitting techniques, the prosthesis can be worn continuously day and night for weeks at a time. Usually once a month, it must be removed for cleaning and deproteinization.
Can I play sports? Can I swim?
Once the prosthesis is fitted, patients can lead a completely normal life and practice all kinds of sports, including water sports.
If I have a blind and painful eye, does this operation effectively remove pain?
Absolutely. This is a situation in which, usually out of fear, patients delay the decision and agree to the surgery after having been in pain for some time. Once performed, they often say they wish they had done it sooner.
BEFORE AND AFTER
case 1
BEFORE:
Esta paciente presentaba las secuelas de un traumatismo con atrofia del ojo (ptisis bulbii). Se recomendó una evisceración con implante orbitario para reponer el volumen ocular y permitir utilizar una prótesis.
after:
Patient with fitted prosthesis after surgery. Note the good mobility of the prosthesis.
case 2
BEFORE:
Patient who suffered an accident with full vision loss and complete ptosis.
after:
Evisceration, prosthesis fitting and ptosis repair were performed.
