Often, as a result of disease or injury, all or a part of the orbital contents, or the parts that make up the eye, must be removed. Depending on the degree of damage that the eye has sustained, there are three different eye removal surgeries that may be appropriate. These surgeries are evisceration, enucleation, and exenteration.
When an eye is removed via evisceration, the inner contents of the eye are removed, but the sclera is left intact. The sclera is outer layer of the eye globe, commonly called the “white of the eye.” An evisceration can be performed in order to increase comfort in a painful blind eye, to remove a tumor in the inner eye, or in some cases, to eliminate infection. After the contents of the eye are removed, an ocular prosthetic that fits over the remaining sclera can be created by a specialist called an ocularist.
Unlike an evisceration, the sclera is removed along with the inner eye contents during an enucleation; however, the eye muscles and other orbital contents are left intact. Typically, as with an evisceration, an ocularist can create an ocular prosthetic that will give a natural look to the eye. Most patients who have been fitted with an ocular prosthetic following an enucleation feel that their prosthetic eye appears so natural that strangers are unable to tell that they have an artificial eye.
Of the three eye removal surgeries, exenteration is the most extreme and is typically performed when there is a danger of disease, such as cancer. A large number of exenterations are the result of skin cancers such as carcinoma or melanoma spreading to the eye tissue. With an exenteration, the eyeball and all of the surrounding tissue of the eye, sometimes including the eyelid are removed. In the past, the majority of people who had had this procedure wore an eye patch, but technology now allows for a combination of prosthetics and sometimes, reconstructive surgery to be used in order to achieve a natural appearance.
All of these surgeries are usually performed by an ophthalmic surgeon or an ophthalmologist. Most often general anesthesia is administered and the patient feels no pain during the operation. After the surgery, most people have a headache that is treated with over the counter pain killers and a regimen of antibiotics is prescribed to prevent infection. Most patients are able to leave the hospital the day after surgery.
As soon as two weeks after the surgery, depending on how quickly the eye socket is healing, the process for receiving an ocular prosthetic can begin. Patients are given a temporary artificial eye to maintain the size of the socket while an artificial eye is hand crafted to match the remaining eye by an ocularist. After the artificial eye is completed and inserted into the eye socket, they require very little maintenance and achieve a natural look.
Following removal of the eye, most people learn to compensate for the loss of vision in that eye rather quickly. Thanks to modern surgical techniques and realistic looking prosthetic eyes, the quality of life comparable to life before eye removal can be achieved.