ENUCLEATION SURGERY

This leaflet gives you information that will help you decide whether to have an enucleation. You might want to discuss it with a relative or carer. Before you have the operation, you will be asked to sign a consent form and so it is important that you understand this leaflet before you decide to have surgery. If you have any questions, you may wish to write them down so that you can ask one of the hospital staff.

The condition

Your eye surgeon has suggested that an enucleation may be of benefit to you to improve the cosmetic appearance of your eye or to remove an uncomfortable or painful blind eye.

If the operation is not performed the condition of your eye will probably remain about the same but it may shrink or become painful.

Waiting for a longer period of time for surgery does not usually affect either the type of operation needed or the outcome of surgery.

The operation

The purpose of the operation is to remove your damaged or blind eye. Usually an implant is placed within the orbit [the bony socket which surrounds the eye] to restore volume and to allow the subsequent fitting of an artificial eye.

An experienced eye surgeon will carry out the operation or may supervise a doctor in training who also performs some operations.

The operation is performed under general anaesthetic and normally takes about 60minutes, but may take longer.

During the operation the surgeon makes a cut around your eye and frees it up by releasing the muscles and the nerve at the back. An implant is then inserted into the space where the eye used to be and the muscles are stitched back in their previous positions. This enables the implant to move in the same way as your eye did. The implant is then covered over by the conjunctiva [ the membrane which covers the white of your eye].

A shell is then inserted between your eyelids and in front of the implant and the orbit firmly padded to reduce swelling.

After the operation

The pad over your “eye” will be removed after 24-48 hours. It is likely that you will feel quite bruised following the operation and you may need some pain relievers. You may need to stay in hospital for a few days.

We suggest that you take a pain reliever such as paracetamol, or ibuprofen when you get home and place cold compressed over the “eye” to reduce swelling for a few days. The clear plastic shell will be left in place to maintain the shape of the lids and conjunctiva whilst the “eye” heals.

It is normal for the “eye” to feel itching and a little sticky and uncomfortable for a while after surgery. Some fluid / bleeding / discharge is common. In most cases, healing will take over about 6 weeks after which point you can be measured and fitted with an artificial eye if this is what you want.

Whilst you eye is healing it is advisable to avoid strenuous exercise, exertion and hot baths. You should also do you best to keep out of dirty environments and please don't rub the eye.

You will be given ointment to place within the eyelids and the hospital staff will explain how and when to use them.

Certain symptoms could mean that you need prompt treatment.

Please contact the hospital immediately if you have any of the following symptoms:

• Excessive pain

• Increasing redness / discharge of the eye

Benefits and risks of enucleation

Once the inflammation has subsided and an artificial eye has been fitted your eye should be comfortable and cosmetically acceptable. Although the artificial eye will move, the amount of movement is variable but will not be as much as a normal eye.

You should be aware that there is a small risk of complications, either during or after the operation.

Some possible complications during the operation

• Bleeding

• Insufficient space for a large implant

• Technical failure

Some possible complications after the operation

• Bruising of the eye or eyelids

• Infection of the implant

• Poor cosmetic appearance  – deep upper lid groove / sunken eye

• Exposure / extrusion of the implant – may occur in the long-term

• Allergy to the medication used

• If your eye was infected at the time of enucleation there is a small risk of developing meningitis.

In a small proportion of cases, further surgery may be needed.

We hope this information is sufficient to help you decide whether to go ahead with surgery.

Please use the space below to write down any further questions to ask the doctor or nurse when you come to the hospital for your appointment. Don't worry about asking questions. Our staff will be happy to answer them.

An artificial eye.

Following your enucleation you will be referred to the Artificial Eye Service. It is usually possible to take an impression from behind the eyelids for a custom made artificial eye about 6 weeks after your operation. Whilst this custom made eye is being prepared you will usually be provided with an “off the shelf” eye.

​