|Evisceration, Enucleation, and
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.