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Evisceration, Enucleation, and Exenteration
by Wadih Zein, M.D.

Evisceration, Enucleation, and Exenteration are the three main surgical techniques by which all or part of the orbital contents are removed. Evisceration is the removal of the contents of the globe while leaving the sclera and extraocular muscles intact. Enucleation is the removal of the eye from the orbit while preserving all other orbital structures. Exenteration is the most radical of the three procedures and involves removal of the eye, adnexa, and part of the bony orbit.

Evisceration is usually indicated in cases of endophthalmitis unresponsive to antibiotics and for improvement of cosmesis in a blind eye. Enucleation is indicated for the above two conditions as well as for painful eyes with no useful vision, malignant intraocular tumors, in ocular trauma to avoid sympathetic ophthalmia in the second eye, in phthisis with degeneration, and in congenital anophthalmia or severe microphthalmia to enhance development of the bony orbit. Exenteration is indicated mainly for large orbital tumors or orbital extension of intraocular tumors.

Issues to consider (and to discuss with the patient) are the irreversibility of the visual loss, the fact that the globe will be removed and the need for a prosthesis in a couple of months time, the different types of  implants and the pros and cons of each, postop motility and rehabilitation, and the complications of the procedures (e.g. extrusion, transmission of viral infections with donor grafts, infection of the prosthesis....). It's also very important to recommend safety glasses for the fellow eye (e.g. polycarbonate lenses) as well as a regular eye checkup.

 

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