An enucleation is the surgical procedure to remove an eye, the volume lost is then replaced by inserting an implant.
The two most common indications for this operation is for tumour removal or a non-seeing eye that is painful.
When the eye is removed there is loss of volume from the eye socket that will give the patient a sunken appearance if the volume is not replaced. Modern implants are made from a variety of materials with structures similar to coral being full of tiny interconnecting tunnels through which blood vessels and tissues of the socket can grow. In this way the implant is incorporated into the patient’s body lessening the chance of rejection or displacement of the implant.
Upper eyelid surgery will give a smoother, less heavy and tired appearance of the upper lid. Lower eyelid surgery aims to achieve a smoother appearance under the eyes and reduce bags and wrinkles. During the operation the muscles that allow the eye to move are attached to the implant so that eventually when the artificial eye is fitted it will move as normally as possible.
Who is suitable for Enucleation surgery?
Any patient with a non-seeing eye that is having enough pain to interfere significantly with quality of life that cannot be effectively controlled with pain-killers or anti-inflammatory eye drops, can have this surgery.
Of course any patient who has had tumour within the eyeball diagnosed that cannot otherwise be treated will need an enucleation.
The procedure is usually performed under a general anaesthetic, however if this is not possible due to medical reasons the procedure can be performed under a local anaesthetic with sedation.
What are the symptoms?
The most common indication is intractable pain in a non-seeing eye. The pain can be so severe as to affect mood and stop patients from taking part in the usual activities of daily living.
A tumour within the eye, may cause pain or decrease vision or potentially can be practically asymptomatic.
What does the treatment involve?
The operation takes about one and a half hours. Usually patients are kept in hospital for 1-2 days post-operatively as sometimes stronger pain relief will be needed during this period.
The muscles that move the eye are attached to the implant so that it moves with the normal movement of the remaining eye. This will allow some movement of the overlying prosthesis to give a more natural appearance.
How will I look immediately after surgery?
After surgery you will be required to wear a bandage for 1 week. Once this has been removed you continue to wear a clear plastic shell called a conformer, which is like a large contact lens inserted during surgery. The conformer is used to reduce contraction and scarring of the socket as well as make the socket more comfortable. It also gives the eyelids a more natural shape. These conformers require some care and this will be explained to you at your post op appointment. If the conformer falls out, do not panic, keep it safe and call Dr Wilcsek during office hours.
Before fitting the prosthesis (model eye), the area will have to heal and associated inflammation settle fully. This usually occurs 6-8 weeks after the operation, during this time the eyelid will be quite droopy and there will only be the conformer in place so for cosmetic reasons some patients prefer to wear an eye patch.
What is the recovery time?
There will inevitably be some discomfort but few patients experience much pain after the first 24-48 hours. Most patients will stay in a hospital overnight, so their pain can be effectively managed. Some patients, however, do experience more severe pain and prolonged pain. The pain is controlled with simple painkillers but stronger painkillers can also be provided. The pain is usually associated with eye movement. This can be minimised by moving the head and limiting eye movements.
After approximately 6 weeks, Dr Wilcsek will refer you to an “ocularist” who will make your artificial eye. This will require about 2-3 weeks. Dr Wilcsek will then review you once the prosthetic eye has been fitted.ly.
What are the risks?
There is risk associated with any surgery and general anaesthetic also carries a low level of risk. Some of the risks of this type of surgery include the risk of infection, bleeding and breakdown of the wound but these complications are rarely encountered. If the tissue placed over the implant thins, the implant may become infected and then exposed.
The implant can be coupled directly to the artificial eye and may increase the amount of movement of the artificial eye. About 6 months after the initial procedure a hole is drilled into the implant and a peg inserted. Having a peg can cause other problems and so the decision to go ahead with this phase should be considered very carefully.
How long do the results of the surgery last?
It is possible that after surgery the implant may not be enough to replace the volume of the eye and the eyelids may appear sunken. In some cases a further implant can be placed under the initial implant to increase volume. As people age there is a tendency to lose fat from the orbit (eye socket) and so this sunken appearance can occur years after the initial procedure.
Sometimes the weight of the prosthesis can cause stretching of the upper or lower eyelids and surgery may be required to improve the cosmetic appearance. This can usually be performed under local anaesthetic.
Is there anyone who shouldn't have this surgery?