ENUCLEATION

It is the removal of the entire eye and part of

the optic nerve
Indication –
Severe injury resulting in uveal tissue
prolapse
Loss of perception
An irritated, blind, painful, deformed or
disfigured eye usually caused by extreme
glaucoma, retinal detachment
An eye without useful vision
Intra ocular tumors that is untreatable by
other means
The procedure involves
Separation and cutting of each of the
ocular muscles
Dissection of the tenon’s capsule (fibrous
membrane covering the sclera)
Cutting of the optic nerve form the eyeball
Insertion of an orbital implant
A large pressure dressing is applied over
the area
Evisceration

Surgical removal of the intraocular

contents through an incision or opening in
the cornea or sclera
Indications
Ocular trauma with ruptured globe
Severe ocular inflammation or infection
The optic nerve, sclera, extraocular
muscles and sometimes the cornea are left
intact
Advantage of evisceration over enucleation
is that final cosmetic result and motility
after fitting the ocular prosthesis are
enhanced
 Exenteration
Removal of the eyelids, the eye, and various
amounts of orbital contents
Indications
Malignancies in the orbit that are life
threatening
All other surgical management is not
possible
Ex- squamous cell carcinoma of paranasal
sinuses, skin and conjunctiva with deep
orbital involvement
In most extensive cases it include removal
of all orbital tissues and resection of the
orbital bones.
Ocular prostheses

Orbital implants and conformers (ocular

prostheses usually made of silicone rubber)
This maintains the shape of the eye after
enucleation and evisceration to prevent a
contracted, sunken appearance
This will protect suture line, maintain the
fornics and promote integrity of the
eyelids.

Ocular prosthetics have limitations in their
motility
Two designs of eye prostheses
Anophthalmic ocular prostheses
Scleral shells
Eye prosthesis usually lasts about 6 years
When the socket is completely healed, the
doctors refer them to ocularist (specially
trained and skilled professional who makes
eye prostheses)
Light weight
orbital prosthesis
with or without
specs
Management

Removal of eye have physical, social and

psychological problems for patients
The patients preparation should include
information about the surgical procedure
and placement of orbital implants and
conformers
Availability of ocular prosthetics
 Teaching about post surgical
and prosthetic care
Inform them there will be large ocular pressure
dressing – typically removed after a week
Ophthalmic topical antibiotic ointment applied in
the socket three times daily
Take extra caution in their ambulation and
movement to avoid injury
Inform 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
 Self care teaching

Teach how to insert, remove and care the

prosthetic eye
Proper hand hygiene must be obtain before
inserting and removing ocular prosthesis
A suction cup can be used to remove the
prosthesis
Avoid falling of prosthesis in the floor
When instructing – a return demonstration is
important to assess the level of understanding
Hygiene and comfort is mandatory
Daily irrigation of the prosthesis with normal
saline, contact lens solution or artificial tears
Removing crusting and mucous discharge that
accumulate over night is performed with the
prosthesis in place.
Malpostion can occur while wiping or rubbing
Use a clean finger to reposition it
Sometimes lubrications is used - irritation
Inspect socket daily for any infections or
secretions
Any unusual discomfort, irritation or
redness should be reported