Evisceration

Evisceration is a type of eye removal surgery. A surgeon will remove the contents of your eye but leave the scleral shell, your eye muscles and other parts attached to your eye intact. The scleral shell is part of your sclera. It’s the white part of your eye that wraps around the outside of your eyeball.

Your eye doctor might suggest evisceration to treat:

• Endophthalmitis or other serious eye infections
• A severe eye injury
• End-stage eye
• A painful sightless eye
• Cosmetic issues with a sightless eye
• Microphthalmia

Your surgeon will put a temporary implant into the empty space. This will help it retain its shape. You can choose a more permanent prosthetic eye after you recover from evisceration.

What does evisceration mean?

The definition of evisceration is removing the insides of something, especially organs.

Evisceration of the eye is taking out your eye’s contents but leaving the shell in place. It’s different than enucleation. That’s surgery to remove your whole eye, including the white part and part of your optic nerve.

How should I prepare for this procedure?

Tell your surgeon about any medications you take. This includes prescriptions and over-the-counter medicine. Make sure to mention any supplements you use. You may have to stop taking some medications before the procedure. Especially if you take blood thinners.

Your surgeon will also let you know when you should stop drinking and eating before evisceration. You’ll probably need to fast for several hours.

You’ll need to arrange transportation. You won’t be able to drive yourself home after the operation.

Your surgeon may suggest that you meet with an ocularist before the evisceration. This is a technical artist who designs and makes prosthetic eyes. Your ocularist will fit you with a prosthetic eye after your surgeon says it’s safe to have one made. This is usually six to eight weeks after surgery.

What happens during evisceration?

An anesthesiologist will give you medicine so you don’t feel pain during surgery. It’s common to use general anesthesia. This will put you to sleep. Local anesthesia that numbs the area around your eye is another option. Your anesthesiologist will probably also give you a sedative if they’re not putting you to sleep.

Evisceration usually about an hour. Your surgeon will:

• Separate the contents of your eye from the sclera
• Take out your eye’s contents
• Insert an implant, which will help replace the volume in your orbit
• Cover the implant with tissue from your eye socket and place a conformer (conformers are contact lens-like pieces that fill your eye socket before you get a prosthetic eye)
• Temporarily sew your eyelid shut (this helps keep your eye socket safe while you heal)
• Put a pressure bandage over your eye, which will gently press on the surgery site (this will protect it, prevent bleeding and reduce inflammation)

What are the potential benefits and risks?

Eye removal can be the best treatment to protect your health and remaining vision. It’s a safe, effective way to remove damaged tissue. It can also relieve pain. Especially if other treatments haven’t worked.

Evisceration can also help you change your appearance. You can usually customize your prosthesis to match your other eye or your personal preferences.

Evisceration has some risks, including:

• Infection
• Bleeding
• Issues with the implant (including needing it removed)
• Scarring
• Damage to your eyelid or tissue around your eye socket
• Conjunctival cysts
• Pyogenic granuloma

What happens after evisceration?

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

Evisceration is usually an outpatient surgery. This means you should be able to go home the same day. Your care team will let you know when it’s safe to leave.

Your care team will show you how to protect your surgery site. Your provider will prescribe pain medications. You might need antibiotics if your eye was infected. You’ll be able to take over-the-counter pain relievers like acetaminophen. But your surgeon may tell you to avoid NSAIDS. These can thin your blood and 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. You’ll need to avoid intense physical activities and swimming for several weeks.

Your care team might tell you not to bend over or lift anything heavier than a certain weight limit. Your surgeon will tell you when it’s safe to resume all your usual activities, including exercise and more physical work or hobbies.

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

You can see your ocularist to fit your prosthetic eye several weeks after evisceration. It usually takes six to eight weeks for the tissue in your eye socket to recover enough for this step.

When should I call my healthcare provider?

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

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

When should I call my healthcare provider?

Your surgeon will give you a list of instructions when you leave, which should include details on when to call. These signs and symptoms may include:

• Excessive bleeding
• Excessive pain in your eye or your head that doesn’t improve with the use of pain relievers
• Signs of infection, such as discharge or fever
• Signs of pain in your remaining eye