Enucleation

Enucleation of the eye is surgery to remove your eye, its contents and part of your optic nerve. A surgeon will remove your entire eyeball. They’ll leave the bones in your eye socket. You can get a prosthetic eye implanted after you recover.

Your eye doctor may recommend enucleation to treat:

• Severe eye injuries
• Eye cancers, including intraocular melanoma and retinoblastoma
• Severe infections like acanthamoeba keratitis or endophthalmitis
• End-stage eye
• A painful blind eye
• Cosmetic issues with a blind eye
• Microphthalmia

How should I prepare for eye enucleation?

Your surgeon will discuss the procedure with you. This can be a big decision. They’ll suggest the best surgery based on your unique situation. Don’t be afraid to ask lots of questions. Share any concerns you have ahead of time.

Tell your surgeon about any prescription or over-the-counter medications you take. Make sure to mention any supplements you use. You may have to stop taking some medications before surgery. Especially if you take blood thinners.

You’ll have to stop eating and drinking for several hours before surgery. Your care team will tell you how long you’ll need to fast.

Arrange transportation to and from surgery. You won’t be able to drive yourself home.

What happens during enucleation of the eye?

An anesthesiologist will give you anesthesia to make sure you don’t feel pain during the surgery. You’ll probably get general anesthesia. This will put you to sleep. You might need local anesthesia that numbs the area around your eye. In this case, you’ll also need a sedative to help you relax.

Enucleation usually takes around an hour. It usually follows these steps:

1. Your surgeon will cut your eye loose from the tissue that holds it in place.
2. They’ll remove the eye and put an implant into your eye socket.
3. They’ll sew your eye muscles to the implant. This will help keep it in place.
4. Your surgeon will cover the implant with tissue in your eye socket. Then, they’ll place a conformer. This is a temporary piece, sort of like a contact lens, that will fill your eye socket before you get a prosthetic eye.
5. They’ll temporarily sew your eyelid shut to help keep the socket safe while you heal.
6. Your surgeon will put a bandage over your eye socket. This will apply pressure to help reduce inflammation, prevent bleeding and protect the surgery site.

What are the potential benefits and risks?

Enucleation can be the best way to protect your health and remaining vision. It’s a safe, effective way to remove damaged tissue or treat diseases that might spread to other parts of your body. It can also relieve pain, especially if other treatments haven’t helped.

It can also help you change your appearance. If you don’t like the way your natural eye looks, enucleation can be the first step to getting an ocular prosthetic. You can pick an implant that matches your preferences. This can help you feel more like yourself.

Like all surgeries, there are some risks, including:

• Bleeding
• Infection
• Scarring
• Issues with the implant (including needing it removed)
• Your eyelid drooping or not being able to close your eye
• Conjunctival cysts

What happens after enucleation?

Your care team will move you to a recovery area after eye removal surgery. They’ll make sure you wake up from anesthesia safely. They’ll also monitor your pain level.

You should be able to go home the same day. But your care team will let you know if you’ll need to stay in the hospital overnight.

Your provider will prescribe pain medications. They may give you antibiotics if your eye was infected. You’ll be able to take over-the-counter pain relievers like acetaminophen. Your surgeon may tell you to avoid NSAIDs because they can increase your risk of bleeding. Your care team will tell you which medications are best. They’ll let you know how often you can take pain relievers. And they’ll show you how to care for your surgery site.

What is the recovery time?

It usually takes a month or two to recover from eye enucleation. You’ll need to avoid intense physical activities for a few weeks after the procedure. Don’t bend over or lift anything heavy for about a month. Your care team will tell you when it’s safe to resume your usual physical activities.

You’ll probably need to visit your surgeon a week after enucleation. They’ll remove the pressure bandage. They’ll check on your healing and look for signs of complications at this visit.

After about six to eight weeks, you should be healed enough to meet with an ocularist. This is a technical artist who makes, fits and paints prosthetic eyes. They’ll design your artificial replacement eye.

When should I call my healthcare provider?

Call your surgeon right away if you experience any of the following:

• A fever
• Pain in your eye socket or head that your medications don’t relieve
• Discharge, especially if it’s yellow or green
• The implant falls out
• Nausea and vomiting