Enucleation (Eye Removal Surgery)

Enucleation is an eye surgery that removes the eyeball and its intraocular contents. It leaves the eyelid lining and eye muscles in place. It also includes implant placement of an artificial eye or ocular prosthesis.¹ 

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’ll advise whether or not to continue using them before and after surgery. 

You should also avoid the following before surgery:

• Taking blood thinners, such as anticoagulants and antiplatelets.⁴ These may interfere with surgery.
• Strenuous activity, such as contact sport or swimming, at least two weeks before the surgery.

During Surgery

Set up reliable transportation to and from the facility on the day of surgery. 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. Here’s what happens:

• Anesthesia administration. The surgeon will administer general anesthesia to put you to sleep. Local anesthesia and sedation may relieve pain and help you relax before and after surgery. 
• Eyeball removal. Your surgeon will then remove the eyeball along with its contents. 
• Implant placement. Once the eyeball is removed, they will place a ball-like implant to fill the space in the eye socket.
• Attaching extraocular muscles. Your surgeon will attach your extraocular muscles to the orbital implants if possible. This will enable the movement of the prosthesis (artificial eye). Using orbital implants also provides a more natural appearance.
• Conformer placement. Finally, the surgeon will place a thin plastic shell (conformer) on the eye socket to maintain its shape and reduce swelling.

Your surgeon 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 being discharged 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 two days post-surgery.

During the healing process, your doctor will prescribe painkillers (Tylenol), antibiotics, and/or steroids to ease discomfort and prevent infection. They’ll also provide you with post-operative care instructions. 

You should avoid the following during recovery:

• Lifting heavy objects (more than 10 pounds)
• Activities that strain your eye muscles
• Rubbing your eyes for at least 2 to 4 weeks after surgery

Prepare for a follow-up appointment 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 eye fitting 6 to 8 weeks after surgery.

An ocularist is a medical professional who makes and fits ocular prostheses (artificial eyes). They’ll 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’ll also clean your prosthetic eye during the visit.

Side Effects and Risks of Enucleation

Side effects and complications of enucleation include:⁶

Who Needs Enucleation?

You might be an ideal candidate for enucleation if you have one of the following conditions:

Intraocular Malignancy (Eye Cancer)

A malignant tumor on the eye can cause vision problems. This can lead to vision loss and other complications. Eye removal surgery prevents further damage or the spread of cancer to other body parts.

A Painful Blind Eye

Some people may experience severe pain with blindness. This may result from conditions like glaucoma, trauma, or infection. Eye removal surgery will help relieve pain. 

Severe Infection 

In some cases, severe infection can leave no room for vision. When this happens, eye removal surgery might be necessary so the infection doesn’t spread to other body parts. 

Sympathetic Ophthalmia 

Sympathetic ophthalmia is severe inflammation after surgery or injury in the fellow eye. Enucleation may be recommended to alleviate pain and avoid further damage from the trauma.

Microphthalmos 

Microphthalmos is when you have abnormally small eyes with malformations.³ Removing the affected eye can provide more benefits, such as comfort and improved vision in the remaining eye.  

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 

Enucleation is the surgical removal of the entire eyeball (globe) from the socket. It’s usually preferable over evisceration in cancer, trauma (severe injury), or eye infection. 

On the other hand, 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 is a surgical technique that takes less time and is less invasive than enucleation. Only some people, however, are good candidates for it.

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. The doctor kills the eye tumor during radiotherapy by subjecting the tissues to radiation.

According to research, plaque radiotherapy is a viable alternative to enucleation in people with juxtapapillary choroidal melanoma (a 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 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.

Summary

Enucleation is a surgery that involves the complete removal of the eyeball. It’s recommended when the entire eye is damaged or diseased, such as in cases of cancer, trauma, or infection. 

Various risks are associated with this eye removal surgery. It's also the last resort when other methods of treatment fail. 

Consult an eye doctor for a comprehensive evaluation to know whether you're a good candidate for the surgery.