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Enucleation – Eye Removal Surgery Explained

Enucleation is a surgical procedure in which the entire eyeball is removed. It is performed in cases of severe eye injuries, tumors, or incurable eye diseases.

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Things worth knowing about "Enucleation"

Enucleation is a surgical procedure in which the entire eyeball is removed. It is performed in cases of severe eye injuries, tumors, or incurable eye diseases.

What is Enucleation?

Enucleation (Latin: Enucleatio bulbi) refers to the complete surgical removal of the eyeball (bulbus oculi) from the eye socket (orbit). The eye muscles, fatty tissue, and conjunctiva remain in place and are used for the subsequent fitting of an ocular prosthesis. Enucleation is considered a major ophthalmological procedure and is only performed when no other treatment option is available.

Causes and Indications

Enucleation is typically performed due to medical necessity. The most common reasons include:

Malignant tumors: Cancerous eye tumors such as uveal melanoma (choroidal melanoma) or retinoblastoma (a malignant retinal cancer, especially in children) may require enucleation when other therapies are no longer effective.
Severe eye injuries: Traumatic eye injuries that cannot be reconstructed -- for example, following accidents -- may necessitate removal of the eyeball.
Sympathetic ophthalmia: A rare autoimmune condition in which an injured eye triggers an immune attack on the healthy fellow eye. Removal of the injured eye may be performed to protect the healthy eye.
Blind, painful eye: A permanently blind eye causing severe chronic pain -- for example, due to untreatable glaucoma or severe inflammation -- may be enucleated to achieve pain relief.
Cosmetic reasons: In rare cases, enucleation may be performed on a disfigured, blind eye to improve external appearance.

Diagnosis and Preoperative Assessment

Before enucleation, comprehensive diagnostic examinations are conducted to confirm the indication and plan the surgery:

Ophthalmic examination: Slit-lamp examination, fundoscopy (examination of the fundus of the eye), and visual acuity testing to assess the affected eye.
Imaging: Ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) to accurately assess tumor size, location, and possible spread.
Biopsy: If a tumor is suspected, a tissue sample may be taken for histological confirmation of the diagnosis.
General medical evaluation: Blood tests, ECG, and anesthesia consultation to prepare for surgery under general anesthesia.

Treatment and Surgical Procedure

Enucleation is typically performed under general anesthesia. The surgical procedure involves the following steps:

Severing the eye muscles, the optic nerve, and the blood vessels supplying the eye.
Complete removal of the eyeball from the orbit.
Insertion of an orbital implant (usually made of porous polyethylene or hydroxyapatite) to restore orbital volume and support movement of the future prosthesis.
Attachment of the eye muscles to the implant, enabling the ocular prosthesis to perform natural-looking movements.
Suturing the conjunctiva over the implant.

After healing -- typically 4 to 6 weeks after surgery -- an individually fitted ocular prosthesis (artificial eye) made of glass or acrylic is crafted to achieve the most natural appearance possible.

Aftercare and Rehabilitation

Postoperative care following enucleation includes:

Regular ophthalmic check-ups to monitor wound healing and prosthesis fit.
Cleaning and maintenance of the ocular prosthesis according to medical instructions.
Psychological support, as the loss of an eye can represent a significant emotional burden.
For cancer patients: oncological follow-up examinations for early detection of recurrence or metastases.

References

Augustin, A. J. (Ed.): Ophthalmology. 3rd Edition, Springer Medizin Verlag, Berlin/Heidelberg, 2007.
Shields, J. A. & Shields, C. L.: Eyelid, Conjunctival, and Orbital Tumors. 3rd Edition, Wolters Kluwer Health, Philadelphia, 2016.
American Academy of Ophthalmology (AAO): Clinical Guidelines on Ocular Oncology and Orbital Surgery. Available at: https://www.aao.org (last accessed 2024).

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