Encyclopedia - Enucleation

What happens during the surgery?
How will you look afterward?

Enucleation is surgical removal of the eyeball, leaving eye muscles, eyelids, brow, and surrounding skin intact (See Anatomy of the Eye. The procedure is recommended only when all alternative treatments to preserve the eye have been exhausted or are inappropriate. Enucleation is typically performed to eliminate a life-threatening tumor within the eye, alleviate pain in a blind eye, or remove an eye severely traumatized by infection or injury.

What happens during the surgery?

Enucleation is a relatively simple operation that is normally performed under general anesthesia and takes about one to two hours. After the eye is removed, it is replaced with a plastic implant that is slightly smaller than the natural eye. This implant is designed to replace the volume in the socket that had been taken up by the eye. Muscles are reattached around the implant, and then the implant is covered with the conjunctiva, which is sewn into position to allow for healing. Sometimes a clear, plastic shell, known as a conformer, is placed behind the lids to give some shape while the socket heals.

Upon completion of the surgery, the eye is covered with a pressure pad and, although some patients may go home the same day, most stay in the hospital for one or two days. Pain relievers are prescribed as needed. Once the patch is removed, the eyelids may be swollen or bruised. Oral medications and eye drops and/or ointments are normally administered 2 to 3 times a day for several weeks.

Enucleation is a very safe procedure, and you will rarely experience significant complications, although the possibility exists. Complications can include, but are not limited to, bleeding, infection, swelling, and scarring.

How will you look afterward?

After the eye socket heals, usually in three to six weeks, a specialist who makes artificial eyes will fit you for an ocular prosthesis. It is painted to resemble the other eye and inserted between the eyelids. The cosmetic appearance after enucleation is usually quite good, although your artificial eye may not move as well as your natural eye, and there may be some difference in the positions of the eyelids. Because you have sight only in one eye, depth perception is impaired. The human brain is very adaptable, however, and over time, you will relearn the skills of depth perception.

Enucleation is a traumatic procedure for most patients, and feelings of shock, depression, and concern about appearance are natural reactions to having an eye removed. Most patients adjust quickly, however, and continue to live a normal, happy, productive life. Be sure to provide extra protection for your remaining normal eye.