Surgery for Eye Removal: Evisceration, Enucleation, and Exenteration

One of the most serious but necessary procedures performed by Jennifer Murdock, MD is surgery involving removal of the eye. Unfortunately, people experience different injuries, develop malignant cancer, or have long-standing ocular disease, like severe glaucoma, that can result in a blind eye that is very painful.

While removal of the eye may sound like a daunting situation, most patients find improved quality of life or a higher chance of survival in cases involving cancer after surgery. Surgery for eye removal are considered last-resort options when all other treatment options have failed to preserve the eye or when leaving the eye in place poses a greater risk to the patient’s health.

Jennifer Murdock, MD understands that a thorough understanding of an eye removal procedure and the expectations after surgery are of the utmost importance. This is why Dr. Murdock will spend a great deal of time discussing the surgical details, options, benefits, and risks with patients and their family members to ensure a comfortable and enjoyable experience after eye removal. There are 3 different options that Dr. Murdock may recommend, depending on each individual’s presentation and medical issues.

Evisceration

Evisceration is a surgical procedure that involves the removal of the eye’s contents while leaving the sclera (the white part of the eye) and conjunctiva (the mucous membrane that covers the front of the eye and lines the inside of the eyelids) intact. This procedure is typically performed to relieve severe pain in an eye that has already lost vision or to improve the cosmetic appearance of a damaged eye due to trauma or injury. Evisceration is often chosen when there is no risk of intraocular cancer, as it can provide a good cosmetic outcome with the placement of an ocular implant within the remaining scleral shell.

Indications for Evisceration

Intractable pain in a blind eye
Severe eye infection or inflammation not responding to treatment
Traumatic injuries to the eye where vision cannot be restored

During this type of surgery, the removal of the contents of the eye allow for the outer scleral shell of the eye to remain intact. Thus, the muscles that move the eye in different directions remain attached to the scleral shell. A permanent implant is placed into the scleral shell to provide volume to the eye socket. The remaining sclera and conjunctiva (pink skin-like covering of the eye) are then sutured closed so that a healthy pink eye socket remains. The eyelids are left intact. Once the socket heals after surgery, a prosthetic can be placed into the eye socket that looks and moves like a real eye.

Evisceration, Enucleation, and Exenteration Before & Afters

Enucleation

Enucleation involves the surgical removal of the entire eyeball, leaving the eye muscles and remaining orbital contents intact. This procedure is typically indicated for patients with intraocular tumors, such as retinoblastoma or melanoma, to prevent the spread of cancer. It can also be performed in cases of severe eye trauma, painful blind eye, eyes that have any implants (like a tube shunt or scleral buckle), or end-stage glaucoma. After enucleation, a spherical orbital implant is usually placed into the empty eye socket occupy the space of the removed eyeball, and eventually, an artificial eye (prosthesis) is fitted to match the appearance of the other eye.

Indications for Enucleation

Intraocular tumors
Severe eye trauma
Painful blind eye due to various causes
Uncontrolled glaucoma

During an enucleation, the conjunctiva remains in place, and the eye muscles are detached from the globe, or eyeball. The eye removal is completed by severing the main ophthalmic artery and optic nerve behind the eye. An orbital implant is placed in the eye socket to provide volume. The muscles that move the eye are reattached to this new implant, so that the prosthetic that is made later on can have some natural movement. The layers of the Tenon’s capsule and conjunctiva are closed over the implant so that a pink, healthy eye socket remains. The eyelids remain intact.

Once the socket is healed, a prosthetic eye is made by a specialist called an ocularist. An ocularist hand-makes each individual prosthetic, unique to the patient’s socket shape and appearance of the healthy eye. No 2 prosthetics are exactly alike. When the prosthetic is in place, sometimes it’s even hard for Dr. Murdock to tell which is the real eye and which one is a prosthetic! Our patients can achieve very natural results after this eye removal procedure.

Exenteration

Exenteration is the most extensive form of eye removal surgery, involving the removal of the entire contents of the eye socket (orbit), including the eyeball, surrounding fat, muscles, and sometimes the eyelids, bones, and other adjacent structures. This procedure is reserved for severe cases where malignant tumors of the eye or orbit are present, or in instances of unmanageable infection or necrosis. Exenteration requires significant reconstruction with a surgical team of specialists that may include an orbital surgeon, ENT surgeon, and sometimes even neurosurgeon. This aggressive surgery is followed by the use of facial prosthetics to improve cosmetic appearance.

Indications for Exenteration

Orbital tumors
Severe orbital infections
Necrotizing orbital cellulitis
Orbital involvement in systemic diseases
Tumors of the eye that have extended beyond the eye

Postoperative Care and Rehabilitation

After eye removal surgery, patients require careful postoperative care to promote healing of the eye socket (anophthalmic socket) and adjust to the loss of an eye. This care includes managing pain, preventing infection, and adapting to changes in vision and depth perception. Rehabilitation services, including support from ophthalmologists, optometrists, and ocularists, are essential to help patients adapt to their visual impairment and to fit and maintain their ocular prosthetics. Dr. Murdock also specializes in managing the anophthalmic socket after eye removal, should any late complications occur.

Complications and Challenges

While eye removal surgeries are generally safe, complications can occur, including infection, bleeding, implant extrusion, and issues with prosthetic fit. Psychological support is also crucial, as the loss of an eye can have a significant emotional and psychological impact on a patient. Dr. Murdock understands that this is a difficult journey, and she will be there to provide a smooth transition through and after surgery with all of her patients and family members.

Trust an Orbital Specialist

Surgery for eye removal, encompassing evisceration, enucleation, and exenteration, represents a spectrum of surgical interventions used to address severe eye conditions that cannot be managed by other means. When other treatment options have failed, Jennifer Murdock, MD is the board-certified orbital surgeon that can best manage this serious issue. Dr. Murdock has extensive surgical experience in all 3 of these types of eye removal surgeries. She can also connect patients with ocularists and low vision centers in South Florida to help patients best establish their normal lives after surgery.

These surgical options for eye removal play a crucial role in alleviating pain, removing diseased or damaged tissue, and preventing the spread of infection or cancer. Despite the challenges and complications associated with these surgeries, advances in surgical techniques, prosthetic design, and rehabilitation services have significantly improved the outcomes and quality of life for patients undergoing eye removal surgery. Experience counts, and Dr. Murdock is available to provide the best care for your needs in Miami, FL.