Cancer, trauma, and other issues may indicate a need to remove one of your eyes. (Learn More) Your doctor will recommend either enucleation or evisceration to remove the problematic eye.

Both procedures have similarities. Enucleation involves removing the entire eyeball but leaving the eye muscles and other orbital contents present. With evisceration, just the contents of the eye and cornea are removed; the sclera (white part of eye) remains.

Evisceration is considered the easier of the two, but not everyone qualifies for it. In many cases of infection or trauma, enucleation is usually the preferred method. (Learn More)

Once your eye is removed, your doctor will talk to you about prosthetic options. They will also provide instructions about how to care for the open eye socket. (Learn More)

woman wearing eyepatch

Reasons for Eye Removal

Enucleation has been performed since the mid-1800s. Today, it is performed for multiple reasons.

  • Retinoblastoma, uveal melanoma, or certain other cancers of the eye
  • Painful, blind eye
  • Microphthalmos (a disorder in which one or both eyes is abnormally small and malformed)
  • Trauma
  • Sympathetic ophthalmia (a unique type of inflammation that occurs after surgery or trauma to the eye)

Whether enucleation is right for cases of acute trauma remains controversial, especially when someone is unable to consent, or they have an altered mental status. When the above conditions are present, doctors typically seek out other possible treatments first.

Removing the eye is a treatment option that is typically only considered when all other possibilities have been exhausted.

Eye Removal Procedures

There is only one procedure for enucleation. When considering this procedure, doctors will also consider evisceration and weigh the pros and cons of each procedure. Some research shows that evisceration can be the better choice for some people due to its lower incidence of complications after surgery and a better cosmetic outcome.

When someone has evisceration, the doctor only removes the intraocular elements of the eye. The person’s sclera, conjunctiva, Tenon’s capsule, and optic nerve remain in place. With enucleation, the entire eyeball is removed.

Before surgery, the doctor will provide either deep sedation or general anesthesia. The surgeon detaches the muscles that are attached to the eyeball and removes it from the eye socket.

After the surgery, a pressure bandage is applied over the eye. It is important to reduce bruising and swelling following the procedure. Approximately one week after enucleation, the doctor will remove the bandage. It is imperative that you do not remove this bandage on your own.

After the surgery, most people are able to go home the same day. For most people, the discomfort is minimal and usually associated with the pressure that comes from the eye patch. The surgeon will provide pain relief options for you to use at home. Many people describe the discomfort as similar to how your muscles feel the morning after a vigorous workout.

Infection and bleeding are relatively uncommon, but they are risks that you need to know about. Long term, it is possible to experience eye socket irritation, discharge from the socket, and exposure of the implant.

Once the eye is removed, a conformer is put into the eye socket. This essentially serves as a placeholder for where a prosthesis will go in the future. The conformer is a clear, large, plastic shield that helps the eye socket to keep its shape. It also protects the socket.

On average, a conformer will remain in place for a minimum of two months following the procedure.

Prosthetic Eyes

prosthetic eye

People can opt to have a custom prosthesis made so it looks like they still have an eye in the socket. Once it is ready and the doctor determines the conformer can come out, the prosthesis is put into place.

Prosthetic eyes are designed to look like your natural eye. The prosthesis manufacturer will work to make the eye color as close to your natural eye color as possible, so both eyes match.

There are different materials used to create prosthetic eyes. The materials that are used are compatible with the tissues present in the eye socket. Polymethyl methacrylate, a type of acrylic plastic polymer, is the most common glass eye material. It is resistant to shattering and lightweight.

In some cases, manufacturers opt to use a silicone polymer to create prosthetic eyes.

Some prosthetic implants can move, depending on the implant type the surgeon uses. Some of the newer prosthetic materials are porous, making it possible for blood vessels to grow into the muscles, tissues, and the implant itself.

When eye movement occurs, it is similar to the movement of your natural eye. The primary difference is that the pupil of the prosthetic does not change in size depending on the light level in your environment. However, the overall look is relatively natural compared to prosthetics from decades past.

You can choose to not use a prosthesis following eye removal. However, there will be more follow-up care to ensure the integrity of your eye socket.

Caring for Eye Health After Enucleation

Immediately following removal of your eye, you will have a pressure dressing. Your surgeon will provide you with details on how to care for this. In general, you cannot remove it until the surgeon does. This takes about a week.

Once the dressing is removed, you will be instructed to clean your face as usual. A prescription ointment is commonly prescribed that you will use about twice a day for a period of time specified by your surgeon. After the dressing comes off, you can usually shower as normal. However, for up to two weeks after the procedure, you are usually instructed to avoid going underwater.

It is possible for the conformer to fall out. If this happens, you should clean it according to your surgeon’s instructions and put it back into your eye. Inserting this device is similar to applying contact lenses. However, you can have a health care professional reinsert it if you are not comfortable doing so.

While it is not necessary, you can wear an eye patch during the time you are waiting for your prosthetic eye. You might choose this for cosmetic reasons, as there are no medical benefits. Some people opt for disposable patches, or you can purchase a reusable one.

Once you have your prosthetic, simply follow the instructions provided by your doctor. This typically consists of keeping the prosthetic clean and using the right technique to insert it.

Your doctor will schedule a variety of follow-up appointments after your procedure. It is imperative that you keep all of these, as they allow your doctor to assess how well your eye socket is healing. This is also when you will start working toward getting a prosthetic, if you choose to wear one.

References

Enucleation. (May 2019). American Academy of Ophthalmology.

Evisceration or Enucleation? (September 2007). Eye World.

Enucleation and Evisceration: What to Expect. (September 2018). University of Iowa Health Care.

Eye Removal (Enucleation and Evisceration). American Society of Ophthalmic Plastic and Reconstructive Surgery.

What to Expect After Your Enucleation Surgery. Memorial Sloan Kettering Cancer Center.