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    Understanding the techniques of eye removal

    Enucleation, evisceration, and exenteration may happen to patients you see

    Three techniques used for eye removal: evisceration, enucleation, and exenteration. Each procedure has specific indications, and each procedure has its advantages, disadvantages, and complications.

    The loss of an eye is not trivial and can be very traumatic for the patient; special care should be given to ensure that all preoperative and postoperative concerns are addressed.

    Let’s review each procedure and discuss care of the anophthalmic socket.

    Enucleation

    Enucleation is the removal of the entire eye. Indications for enucleation include intraocular tumors (most commonly melanoma and retinoblastoma) which are unable to be controlled with other methods and blind eyes after trauma.

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    The advantage of an enucleation is it gives a good specimen for the pathologist to determine evidence of spread beyond the eye. The disadvantages of enucleation are it is a longer surgery than evisceration, and the normal anatomy of the orbit is not retained, which predisposes the patient to postoperative complications.

    Enucleations are considered after trauma in situations in which the eye is blind. In this case, enucleation is performed within two weeks of the trauma to prevent sympathetic ophthalmia.

    Sympathetic ophthalmia is a rare condition in which the untraumatized eye becomes inflamed due to the exposure of the immune system to antigens from the traumatized eye, resulting in an autoimmune response to the normal eye. Although rare, the consequences can be devastating for the normal eye.1 In addition, blind eyes after trauma often become painful and do not look normal, giving additional reasons to consider an enucleation.

    The procedure is usually performed under general anesthesia, although it can also be performed with the patient sedated (Figure 1). A retrobulbar block is given prior to starting the surgery to help with postoperative pain and to help prevent bleeding during the surgery with the use of epinephrine in the injection. For eyes with tumors, some surgeons prefer to not give a block because of the risk of perforating the eye with the needle.

    Richard C. Allen, MD, PhD, FACS
    Richard C. Allen, MD, PhD, FACS, is professor of ophthalmology at the University of Texas MD Anderson Cancer Center. He is a member of ...

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