Removal of an eye is a drastic procedure that doctors do as a last resort if no other treatment for a serious eye condition provides relief. In the case of cancer, eye removal may be necessary to prevent its spread to the brain and other organs. There are three types of eye removal — evisceration, enucleation, and exenteration.
Eye removal is never undertaken lightly. Your ophthalmologist will have explored every treatment option available and discussed them all with you before coming to this step. Eye removal is irreversible, and you can't regain vision in that eye.
Three types of procedures can be used to remove an eye:
- Enucleation
- Evisceration
- Eventration
What Is Enucleation of the Eye?
Enucleation is surgery that removes the entire eyeball and its contents. It leaves the eyelids, eyelashes, eyebrows, and surrounding skin. The eyeball is replaced by an orbital implant and prosthesis that looks like your eye.
What Is Evisceration of the Eye?
In evisceration, the surgeon removes the cornea and contents of the eye, leaving the sclera (the white part of the eye) and the eye muscles intact. They then insert an implant into the scleral shell. The sclera is able to move as before because the muscles are still attached.
Enucleation vs. Evisceration
Evisceration is a less extensive procedure than enucleation. Both procedures leave your eyelashes, eyebrows, and eyelashes intact. But evisceration preserves the scleral shell of the eye and the muscles that move the eye.
Evisceration is a simpler procedure to perform than enucleation. It has a slightly higher risk of sympathetic ophthalmitis. This complication can destroy sight in the other eye, leaving you completely blind. If the eye removal is being done for relief from a blind painful eye, evisceration may be less effective since it leaves the ciliary nerves inside the eye intact.
What Is Exenteration of the Eye?
Exenteration is the most extensive procedure. The surgeon removes the entire eyeball, eyelids, eyebrows, and surrounding skin. Exenteration is usually done for the treatment of eye cancer that has spread to surrounding tissues.
Reasons for Eye Removal Surgery
Removal of an eye is the last resort. Your doctor will only suggest it for serious conditions when no other treatment works. Some conditions that necessitate removal of an eye include:
- Intraocular tumors (cancer in the eye), like retinoblastoma or choroidal melanoma
- Severe injury to the eye
- A severely painful blind eye
- Uncontrollable infection in an eye
- A blind, disfigured eye to improve the cosmetic appearance
Sometimes, a doctor may remove an injured eye to protect the other eye. Eye injury can lead to a reactive condition called sympathetic ophthalmitis in the other eye. This can cause loss of sight. Removing the injured eye saves the other eye.
A painful blind eye can be a source of misery. Removal of such an eye provides relief from eye pain, facial pain, and discharge from the eye. Complete relief from pain may happen several months after the surgery.
This surgery leaves you with vision in one eye only. This may make you unhappy, especially if you had vision in the eye that was removed. Losing a part of yourself is always distressing, and you might consider counseling.
Enucleation Surgery
Enucleation and other types of eye removal surgery are usually done under general anesthesia. You will be unconscious throughout the procedure. An anesthetist will examine you before the surgery to make sure you're in good physical health and can stand the anesthesia and surgery.
Your eyeball is protected inside a bony cavity called the orbit. Enucleation of the eye removes the eyeball from the orbit. The optic nerve that carries signals to the brain is cut. The eyeball has several muscles attached to it for movement in different directions. These, too, are detached.
Your surgeon will place an orbital implant in the orbit. The eye muscles are attached to the implant so that it moves like an eye. The eye muscles work in tandem in both eyes, so the implant will move in the same directions as your other eye.
Enucleation leaves the eyelids, conjunctiva, and surrounding skin intact. These are positioned over the socket to give a pink appearance. A few weeks after surgery, your ophthalmologist will give you an orbital prosthesis (artificial eye). This fits over the orbital implant like a contact lens. Your ophthalmologist will teach you how to remove, clean, and replace this prosthesis.
Enucleation Complications
There is a small risk of complications after this surgery:
- Bleeding
- Swelling
- Infection
- Discharge from the socket
- Socket irritation
- Exposure of the ball implant
Eye Removal Surgery Recovery
Recovery from eye removal surgery takes several weeks. Your surgeon will place an ocular conformer over the orbital implant as a temporary measure. This cup-shaped device prevents closure and adhesion during the healing process. Your doctor will remove the conformer after six to eight weeks, once the swelling has subsided and the eye socket has healed.
You may have pain after waking from anesthesia. Your doctor will prescribe medicine to reduce it. They may also prescribe antibiotics to prevent infection. Your eyelids will be bruised and swollen for a few days. Your doctor will teach you how to clean the eye socket before you go home from the hospital.
The dressing on your eye will be removed a day or two after surgery. Keeping your eye uncovered will help it heal, but you can wear dark glasses. Your doctor will prescribe eye drops, oral antibiotics, and pain relievers to use at home.
You must avoid bending and lifting heavy objects for a month. Similarly, you should avoid swimming and intense exercise. You can drive and participate in normal activities in a few days. You should keep the bandage covering your eye dry. Your surgeon will see you a week after surgery to check your healing.
Vision After Eye Removal
The orbital implant and prosthesis provide no vision. They only provide a natural appearance.
Your vision will be from your remaining eye and will be as good as it was from that eye before the surgery. Since you'll be seeing with one eye only, you'll have difficulty with distance or depth perception. Your vision will be as before on the sides of the intact eye and above and below, but you'll have a reduced visual field on the side where your eye was removed. You'll have to move your head to look on that side.
Removal of an eye is an enormously difficult decision. It's done only to relieve you from the misery of a painful blind eye or to prevent the life-threatening spread of cancer. The purpose of such surgery is to free you from pain and enable you to live an unrestricted life.