Eye Enucleation

What is an Eye Enucleation

Eye enucleation is surgery to permanently remove the eyeball (globe). The space that remains (socket) after the eyeball is removed will be filled with an artificial eyeball (implant).

Muscle tissue will be sewn onto the implant to keep the implant in place and to give it some movement. The natural eyeball may need to be removed because of:

  • Injury.
  • Diabetes.
  • Tumors.
  • Eye disease such as glaucoma.
  • Inflammation or infection of the inner eye (endophthalmitis).
  • A painful, blind eye.
  • Abnormal (deformed) eyeball shape.

Removal of your eye may cause strong feelings and changes to self-confidence, self-esteem, and self-image. Talk with your health care provider about these feelings and any concerns you may have.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection around the globe with fluid drainage from the lining of the eyelids (conjunctivitis).
  • Bleeding.
  • Allergic reactions to medicines.
  • The implant changing position (migration) or coming out (extrusion).
  • The socket being too small for the implant.
  • The lower eyelid stretching out so that it cannot support the implant.
  • Drooping of the upper eyelid.

What happens before the procedure?

Medicines

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do not take these medicines unless your health care provider tells you to take them.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • You may be given antibiotic medicine to help prevent infection.
  • You may be given medicine to prevent nausea and vomiting.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

  • You may have an exam or testing.
  • You may have a blood or urine sample taken.
  • You may be asked to shower with a germ-killing soap.
  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.
  • Losing a part of the body can be difficult to accept. Your health care provider should speak with you about your surgery and what to expect after your procedure.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • A surgical instrument (speculum) will be placed around your eye to hold your eyelids open.
  • The tissue that connects the eyeball to the socket (tendons) and the inside lining of the eyelid (conjunctiva) will be cut and separated from the eyeball.
  • The muscles around the eyeball (extraocularmuscles) will be cut away from the surface of the eye.
  • Stitches (sutures) may be placed at the end of the cut muscles to keep them in place.
  • The optic nerve will be cut, and the eyeball will be removed.
  • Bleeding will be stopped using a hot electric tool (cauterization).
  • A ball-shaped implant will be placed in the eye socket. Remaining tissue will be sutured over the implant.
  • Your extraocular muscles will be sutured to the outside of the implant to keep it from migrating.
  • Antibiotic ointment medicine may be applied to the area.
  • A temporary artificial covering (conformer) will be placed over the implant to help the socket keep its shape. It will be removed later when a permanent conformer is ready to be placed.
  • A tight bandage that applies pressure to the area (pressure dressing) will be placed over the socket.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You may be given medicine to help with nausea and vomiting.
  • Your pressure bandage will remain in place until your health care provider tells you it can be removed.
  • Do notdrive until your health care provider approves.

Summary

  • Enucleation surgery permanently removes the eyeball (globe).
  • Removal of your eye may cause strong feelings and changes in how you think or feel about yourself.
  • Losing a part of the body can be hard to accept. Your health care provider should speak with you about your surgery and what to expect after your procedure.

Eye Enucleation, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Some pain and discomfort.
  • Some swelling, bruising, or both around your eye socket or on your eyelids.
  • Watery or pinkish drainage from your eye socket.
  • Feelings of pain, other sensations, or light or images that seem to come from the removed eyeball (phantom eye syndrome).
  • Problems seeing with the one remaining eye (monocular vision), such as limited side (peripheral) vision and limited ability to see distances between objects (depth perception). This should get better over time.

Follow these instructions at home:

Medicines

  • Take or apply over-the-counter and prescription medicines only as told by your health care provider. These include eye drops or ointments.
  • If you were prescribed an antibiotic medicine, take or apply it as told by your health care provider. Do notstop using the antibiotic even if your condition improves.

Driving

  • Do notdrive until your health care provider approves. Ask your health care provider when it is safe for you to drive.
    • Do notdrive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
    • Do notdrive or use heavy machinery while taking prescription pain medicine.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.

Eye care

  • Do not press on or rub your eye socket.
  • Change your bandage (dressing) as told by your health care provider. Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • If your artificial eyeball (prosthesis) falls out, clean it with soap and water, wash your hands, and then put the prosthesis in place between your eyelids. If you cannot put your prosthesis back in, contact your health care provider.
  • Check your eye area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

If directed, put a clean, cool, damp towel (compress) over your eye.

  • If directed, put the towel in a plastic bag.
  • Leave the compress on for 20 minutes, 2–3 times a day.

General instructions

  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
  • Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • If you have a job that requires good vision with a full area of sight, talk with your employer about job safety.
  • You may wear an eye patch to look more natural until you get your natural-looking prosthesis. However, you may heal faster without an eye patch.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have pain or a headache that does not get better with treatment.
  • Your prosthesis comes out and you cannot put it back in.
  • You have a fever.
  • You have more redness, swelling, or pain around your eye area.
  • You have more fluid or blood coming from your eye area.
  • Your eye area feels warm to the touch.
  • You have pus or a bad smell coming from your eye area.
  • You cannot eat or drink without vomiting.
  • You have trouble coping with the loss of your eye.

Get help right away if:

  • You have trouble breathing.
  • You are confused.
  • You have problems speaking.
  • You have severe chest pain.
  • You have a severe headache.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • Take or apply over-the-counter and prescription medicines only as told by your health care provider. These include eye drops or ointments.
  • Do notpress on or rub your eye socket.
  • Change your bandage (dressing) as told by your health care provider.
  • Do notdrive until your health care provider approves. Ask your health care provider when it is safe for you to drive.
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