ENUCLEATION

Enucleation - Is the removal of the entire eye and part of the optic nerve. - It involves the separation and cutting of each of the ocular muscles, dissection of the Tenons capsule, and cutting of the optic nerve from the eyeball. - It may be performed in the following conditions: o Severe injury resulting in prolapsed of uveal tissue or loss of light projection (the ability to identify the direction of light source) or perception. o An irritated, blind, painful, deformed, or disfigured eye, usually caused by glaucoma, retinal detachment, or chronic inflammation. o An eye without useful vision that is producing or has produced sympathetic ophthalmia in the other eye o Intraocular tumors that are untreatable by other means. - The two types of eye tumors that may require enucleation are: 1. Intraocular eye melanoma This is a rare form of cancer in which malignant cells are found in the part of the eye called the uvea, which contains cells called melanocytes that house pigments. When the melanocytes become cancerous, the cancer is called a melanoma. If the tumor reaches the iris and begins to grow, or if there are symptoms, enucleation may be indicated. 2. Retinoblastoma. Retinoblastoma is a malignant tumor of the retina. The retina is the thin layer of tissue that lines the back of the eye; it senses light and forms images. If the cancer occurs in one eye, treatment may consist of enucleation for large tumors when there is no expectation that useful vision can be preserved. If there is cancer in both eyes, treatment may involve enucleation of the eye with the larger tumor, and radiation therapy for the other eye. Evisceration involves the surgical removal of the intraocular contents through an incision or opening in the cornea or sclera. May be performed to treat severe ocular trauma with rupture globe, severe ocular inflammation, or severe ocular infection. Advantage: the final cosmetic result and motility after fitting the ocular prosthesis are enhanced. Recommended for patients whose body image is severely threatened. Disadvantage: high risk of sympathetic ophthalmia. Exenteration The removal of the eyelids, the eye, and various amounts of orbital contents Indicated in malignancies in the orbit that are life-threatening or when more conservative modalities of treatment have failed or are inappropriate.(e.g., squamous cell carcinoma of parinasal sinuses, skin, and conjunctiva with deep orbital involvement.) Ocular Prostheses Orbital implants and conformers (ocular prostheses usually made of silicone rubber)

 Maintain the shape of the eye after enucleation or evisceration to

prevent a contracted, sunken appearance. Temporary conformer Placed over the conjuntival closure after the implantation of an orbital implant. It is placed to: 1. protect the suture line 2. Maintain the fornices 3. Prevent contracture of the socket in preparation for the ocular prosthesis 4. Promote the integrity of the eyelids. 2 designs of eye prostheses: Anophthalmic ocular prostheses- are used in the absence of the globe. Sclera shell- thinner and fit over a globe with intact corneal sensation. Medical management: The pt. preparation should include information about the surgical procedure and placement of orbital implants and conformers and the availability of ocular prosthetics to enhance cosmetic appearance. Pt may see an ocularist before the surgery to discuss ocular prosthetics. Teaching About Postsurgical and Prosthetic Care: Patient who undergo eye removal need to know that they will usually have large ocular pressure dressing, which typically removed after a week. An ophthalmic topical antibiotic ointment is applied in the socket three times a day. After the removal of an eye, there may be a loss of depth perception. Advise to take extra caution in their ambulation and movement to avoid miscalculations that may result in injury. pt must be advised that conformers may accidentally fall out of the socket. If this happens, the conformer must be washed ,wiped dry, and place back in the socket. Providing emotional support is crucial especially when surgery is unexpected. Promoting Home and Community-Based Care: Teaching Pt. Self-Care: Teach how to insert, remove, and care for the prosthetic eye. Proper hand hygiene must be observed before inserting and removing an ocular prosthesis. Suction cap may be used if there are problems with manual dexterity. When instructing a family member or patient, a return demonstration is important to asses the level of understanding and ability to perform the procedure.

Continuing Care: Eye prosthesis can be worn and left in place for several months. Daily irrigation of the prosthesis in place with normal saline solution, hard contact lens solution, or artificial tears to maintain hygiene and comfort. in cases of dry eye symptoms, the use of ophthalmic ointment lubricant or oilbased drops, such as Vitamin E and mineral oil, can be helpful. Removing crusting and mucous discharges that accumulate overnight is performed with the prosthesis in place. prosthesis can be repositioned with the use of clean fingers.(should be gentle temporal to nasal motion to avoid malposition ) Prosthesis needs to be removed and cleaned when it becomes uncomfortable and when there is increased mucous discharge. should be mucous free Inspect for signs of infection. Unusual discomfort, irritation, redness of the globe or eyelids may indicate excessive wear, debris under the shell, or have of proper hygiene. If experienced, consult your doctor. REPORTED BY: MA.THERESA B. BLANCO BSN III- A