Surgical Techniques

There are three types of eye removal and several different options for implant. Orbital implants and ocular prostheses are used by the surgeon to restore a more natural appearance.

Evisceration

• Removal of the internal eye contents, but the sclera is left behind with the extraocular muscles still attached. Either generalor local anesthetics may possibly be used during eviscerations, with antibiotics and anti-inflammatory agents injected intravenously

  An ocular prosthetic can be fit over the eviscerated eye in order to improve cosmesis.

  • Only the contents of the eye (iris, lens, vitreous, retina, and choroid) are removed
  • The leaves behind a pocket of sclera.
  • Improved motility: because the muscles that control eye movement remain attached to the sclera
  • Sclera is filled with an orbital implant or sphere.
  • The sphere may possibly be made of MEDPOR®, PMMA or hydroxyapatite material.
  • This orbital sphere or implant remains permanently
  • A prosthetic eye can be made 6-8 weeks later by an ocularist
  • Contrast with ENUCLEATION 

Enucleation

• removal of the eyeball, but the adjacent structures of the eye socket and eyelids remain. An intraocular tumor excision requires an enucleation, not an evisceration. 
• Enucleation is removal of the eye, leaving the eye muscles and remaining orbital contents intact.
• This type of ocular surgery is indicated for a number of different ocular tumors, in eyes that have suffered severe trauma, and in eyes that are blind and painful due to other disease.
• Auto-enucleation (oedipism) and other forms of serious self inflicted eye injury are an extremely rare form of severe self-harm which usually results from serious mental illnesses such as schizophrenia  The name comes from Oedipus, who gouged out his eyes in penance after having sex with his mother and killing his father
• Details
• The entire eye (iris, lens, vitreous, retina, and choroid) AND SCLERA are removed
• Muscles are detached from the sclera and may possibly be re-attached to the implant
• The implant may possibly be made of MEDPOR®, PMMA or hydroxyapatite material, or may possibly be a dermis fat graft
• This orbital sphere or implant remains permanently
• A prosthetic eye can be made 6-8 weeks later by an ocularist
• contrast with evisceration

 

Exenteration 

• removal of the contents of the eye socket (orbit) including the eyeball, fat, muscles and other adjacent structures of the eye.
• The eyelids may possibly also be removed in cases of cutaneous cancers and unrelenting infection.
• Exenteration is often done together with Maxillectomy which is removal of the maxilla or the upper jaw bone/cheekbone
• An exenteration removes the entire ORBITAL contents, the eye, the muscles which control eye movement, and generally the eyelids.
• Since the orbit is empty, implants are more difficult to create some may possibly be attached to eyeglasses, others to the orbit with the help of magnets
• Note there is no soft tissue within the orbit.