Enucleation Eye Surgery

What is Enucleation?

Enucleation is the surgical removal of the eyeball and its intraocular contents. It leaves the eyelid lining and eye muscles in place. It also includes implant placement of the artificial eye.¹ 

What’s the Difference Between Enucleation and Evisceration?

Enucleation and evisceration are both eye removal surgeries. The main difference is the parts that are removed during the surgery.²

While enucleation involves the removal of the entire eyeball (globe) from the socket, evisceration only removes the cornea and the other contents of the eyeball. It leaves the sclera (white of the eye) and eye muscles intact.

Evisceration takes less time and is less invasive than enucleation. Not every person, however, is a good candidate for it.

Enucleation is usually preferable over evisceration in cancer, trauma (severe injury), or eye infection. In most instances, both surgeries produce the same result.

The results in both surgeries cannot be altered or reversed. Talk to your doctor to determine the best surgery for your needs.

Who Needs Enucleation Surgery?

The ideal candidate for enucleation has:

• Intraocular malignancy (eye cancer)
• Blind, painful eye
• Severe infection with no potential for vision
• Sympathetic ophthalmia (severe inflammation after surgery or injury in the fellow eye)
• Microphthalmos (abnormally small eyes with malformations)³

Enucleation Procedure: What to Expect

Expect the following before, during, and after the surgery:

Before Surgery

Before surgery, your doctor will discuss the procedure details with you. Tell them about any medications you’re taking. They will advise whether or not to continue using them before and after surgery. 

In most cases, your doctor may discourage you from taking blood thinners such as anticoagulants and antiplatelets.⁴ These may interfere with surgery.

Avoid strenuous activity, such as contact sport or swimming, at least 2 weeks before the surgery.

During Surgery

On the day of surgery, set up reliable transportation to and from the facility. The effects of anesthesia continue after surgery, which makes driving unsafe. 

Once you arrive at the facility, you’ll be admitted into the operating room. Your surgeon will examine your eyes and prepare you for surgery. They will administer general anesthesia to put you to sleep.

Local anesthesia coupled with sedation may also be administered to relieve pain and help you relax before and after surgery. 

Your surgeon will then remove the eyeball along with its constituents. Once the eyeball is removed, they will place a ball-like implant to fill the space in the eye socket.

If possible, your surgeon will attach the eye muscles to the ball implant. This will enable movement of the prosthesis (artificial eye).

Finally, the surgeon will place a thin plastic shell (conformer) on the eye socket to maintain its shape and reduce swelling.

They may also use a pressure bandage to reduce swelling. The procedure takes about 1 to 2 hours.

After Surgery

Your surgeon will check your eye before you’re discharged from the hospital to ensure everything is okay. They’ll change your dressing and show you how to do it at home. They will also direct you to keep the bandage dry and your eye covered for at least 2 days post-surgery.

Your doctor will prescribe pain killers (Tylenol), antibiotics, and/or steroids to ease discomfort and prevent infection. They’ll also provide you with post-operative care instructions. 

During recovery, avoid lifting heavy objects (more than 10 pounds). Also, avoid activities that strain your eye muscles. Rubbing your eyes is also strictly discouraged for at least 2 to 4 weeks after surgery. 

Prepare for a follow-up visit a week after surgery. During this time, your surgeon will examine your eyes to monitor healing.

Most enucleation patients recover within 2 to 8 weeks.

Prosthetic Fitting

Once your eye is fully healed, your surgeon will refer you to an ocularist. Most people are ready for prosthetic fitting 6 to 8 weeks after surgery.

An ocularist is a medical professional who makes and fits ocular prosthetics (artificial eyes). They ensure the artificial eye resembles your other eye.⁵

Once fitted, your prosthetic eye can last decades with proper cleaning and maintenance. Arrange for a follow-up visit with your doctor at least once or twice a year to check your eye’s health. They will also clean your prosthetic eye during your visit.

Side Effects and Risks of Enucleation Surgery

Side effects and complications of enucleation include:⁶

• Headache
• Damage eye muscles
• Bleeding (rare)
• Scarring
• Superior sulcus deformity (a sunken appearance)
• Eye perforation
• Eye infection
• Socket contraction
• Extrusion (implant falling out)
• Ball implant exposure or dislocation
• Pain
• Ptosis (drooping eyelids)
• Ectropion (when the eyelid sags or turns outwards) 
• Entropion (when the eyelid folds inwards, causing irritation and discomfort)
• Enophthalmos (loss of fat within the eye socket, causing the eye to fall back into the socket)
• Poorly fitted prosthesis
• Orbital cellulitis (infection of the soft tissues behind the orbital septum)

Alternative Treatments

Enucleation is often recommended as a last resort due to its invasive nature and risk of complications. 

Alternatives include:

Evisceration

If the entire eyeball is not damaged, your surgeon may prefer evisceration. This involves partial removal of the eye contents. It’s also less invasive and has a quicker recovery time. 

Radiotherapy

Radiotherapy is an alternative to eye removal. During radiotherapy, the doctor kills the eye tumor by subjecting the tissues to radiation.

According to research, plaque radiotherapy is a viable alternative to enucleation in people with juxtapapillary choroidal melanoma (tumor within 1 mm of the optic disc).⁷

Secondary Orbital Implant Surgery

People who previously received enucleation may experience difficulties with their orbital implant. It may have shifted out of position, been exposed, contaminated, or was just too small. 

In these cases, a second surgery to remove the original implant may be necessary. This is known as secondary orbital implant surgery.⁸ The procedure is more complex than enucleation and is often done under general anesthesia.

Exenteration Surgery

Exenteration is a more invasive type of eye surgery than enucleation, evisceration, or secondary orbital implantation.⁹ It involves the removal of the entire eyeball and the surrounding tissues (muscles, nerves, fat, and eyelids). Disease severity impacts treatment.