Skip auxiliary navigation Press Enter. Skip main navigation Press Enter. Toggle navigation. Print Version What is an enucleation? When is an enucleation necessary? What is an ocular prosthesis? Last Updated By: Christina Scott Related Links No Related Resource entered. Search by Eye Terms Eye Conditions.
Translate page:. When choosing a date for the surgery, keep in mind that strenuous physical activity and swimming are not advised for two weeks after surgery. It also may take up to two months of healing before you can be fitted for a prosthesis. The prosthesis is like a large contact lens, custom painted by the ocularist to resemble your other eye. It fits over the implant placed inside the eye during surgery. You should choose an ocularist and schedule an appointment with them before the surgery.
Ride home. Arrange for a ride home from the hospital. You are not allowed to drive yourself home because driving yourself can be dangerous after receiving anesthesia. You also must be taken home by an adult other than a ride sharing service unless they have special qualifications. You may receive medication for pain, but over-the-counter pain relievers are enough for most patients.
Prescription antibiotics or steroids may be needed in some cases. Swimming, strenuous exercise or other demanding physical activities are restricted for two to four weeks. Bending at the waist and lifting heaving objects should also be avoided for up to a month. You may drive and perform other normal activities as soon as you feel well enough. Ask your surgeon for specific recommendations.
Take care to keep the bandage that is covering the eye dry. Figure 2b. This graphic highlights the tissues removed during an enucleation.
In contrast, an enucleation detaches the extraocular muscles and removes the entire eyeball — both the intraocular contents light blue and the scleral shell dark blue. Figure 3. This graphic depicts the placement of the orbital implant into the eye socket after the patient's has been removed via either evisceration or enucleation. Figure 4. This graphic shows where the conformer sits in the eye socket. Figure 5b. Example of what the clear conformer looks like when it is worn in the eye socket.
Figure 6. This graphic shows where the prosthetic eye sits in the eye socket. Once the custom prosthesis is made, usually around two months after the surgery, it will replace the conformer in the eye socket Figures 6 and 7. Figure 7b. Example of what the prosthetic eye looks like when it is worn in the eye socket. Figure 8. This graphic depicts the entire process of eye removal surgery, from tissue removal to prosthesis use.
Because an evisceration involves less disruption of the orbital tissues, it is a slightly shorter and simpler operation.
However, depending on the reason why the eye needs to be removed, not every patient will qualify for an evisceration. Notably, cancer patients are not good candidates for an evisceration, as it will leave behind tissues that may be malignant. Additionally, enucleation is preferred in certain kinds of trauma and infection to avoid complications associated with those conditions, such as sympathetic ophthalmia. Figure 9. Examples of eye sockets after evisceration left and enucleation right.
Note that both sockets appear similar, regardless of the surgical technique used. Despite the differences in technique, evisceration and enucleation have an identical external appearance afterwards, and both surgeries are effective in reducing pain and creating a suitable pocket for the insertion of a prosthetic eye, which may improve the external appearance of an unsightly eye Figure 9.
Video 1. Demonstration of motility of an eye socket after eye removal surgery. The motility with and without a prosthesis is also very similar between the two surgeries Video 1.
If you are making the decision to undergo eye removal surgery, please note that both evisceration and enucleations are irreversible surgeries. It involves the removal of tissues that are not replaceable. As a result, these surgeries may rule you out as a candidate for restorative therapies that may be developed in the future.
Your preoperative consultation is important to create a plan for the eye removal surgery and determine what other medical issues need to be addressed prior to the procedure.
This ensures that the surgery and anesthesia will be safe to perform. When picking a date for your surgery, please keep in mind that you will need to avoid heavy lifting, strenuous activities, and dirty environments for at least two weeks after the surgery.
You will not be able to swim for three weeks. Additionally, you will need to heal for at least 2 months before you are eligible for prosthesis fitting. Please schedule your surgery accordingly, especially if you have any upcoming events such as weddings, graduations, vacations, or work or social events. This surgery is an outpatient surgery, which means you will go home after the surgery and will not spend the night at the hospital.
You will need a driver that is 18 years or older to take you home and take care of you the night after surgery because it is not safe to drive right after the anesthesia you will be given during the procedure. Before the surgery, you may want to find an ocularist to learn more about the process of making an ocular prosthesis. An ocularist is an artist who specializes in making artificial eyes. It may be more efficient to schedule an ocularist fitting shortly after your surgery so that you can start the insurance verification process and get your desired prosthetic made in a timely manner.
The University of Iowa offers an in-house ocular prosthetics service — click here to learn more. Eye removal surgery requires you to receive anesthesia. Depending on your other medical conditions, there are two types of sedation we may use. For both types of anesthesia, you will have the entire area around the eye numbed for your comfort throughout the surgery.
You will be awake and ready to go home shortly after the surgery. By attaching the rectus muscles to the implant, better movement is obtained. Implants can be made from porous or solid material. Implants come in different shapes. Most commonly, a spherical implant is used, but some implants have mounds on the front that may aid in the movement of the prosthesis. The prosthesis is made by an ocularist four to six weeks after the surgery.
In general, the patient should see the ocularist once a year for prosthesis polishing and checking the fit. The patient will have better success if he does not manipulate the prosthesis himself.
The prosthesis rarely needs to be removed except for examination once a year by the oculoplastic surgeon and ocularist. Implants can become exposed for several reasons: dehiscence of the surgical wound, poorly vascularized conjunctiva, infection of the implant, and mechanical pressure from the prosthesis.
If an implant is exposed, it should be repaired. Techniques for repair depend on the size of the exposure. With time, the patient can lose volume in the orbit, likely due to fat atrophy. The prosthesis may need to be enlargeda large prosthesis does not fit and move as well as a thinner prosthesis.
Due to the potential problems with volume after the surgery, the largest implant possible is placed at the time of the surgery. An enucleation in a children is a special situation. Volume is very important in children to help the orbital bones grow. Sometimes it is useful to implant a dermis-fat graft, which is tissue from the patient that will grow with the patient and help maintain volume and adequate bone growth.
For an evisceration, the contents of the eye are removed and the sclera is retained Figure 3. Eviscerations are often performed for blind, painful eyes. Eviscerations are not performed for eyes that have tumors; in fact, it is mandatory to image ultrasound the eye prior to an evisceration to make sure there is not an unknown or undetected tumor.
In addition, research has shown that the movement of the prosthesis is better after evisceration compared to an enucleation.
0コメント