Anophthalmos is a condition that literally means “without an eye”.
The eyeball consists of several tissue structures. The white part inside the eye is called sclera. This holds the contents of the eye from the optic nerve to the cornea. The cornea is composed of the clear lenses that send image and light messages to the retina. The retina inside the back of the eyeball processes the images and sends them through the optic nerve to the brain.
The eyeball is held in place and moved with six narrow muscles called rectus muscles. A clear elastic membrane called conjunctiva protects the surface of the eye from the cornea to the margins of the eyelids.
Enucleation is the surgical process of removing the entire eyeball from the eye socket. The conjunctiva is opened around the cornea and the muscles are detached from the sclera. The entire eyeball is removed intact along with a portion of the optic nerve.
Evisceration consists of removing the cornea and the internal contents of the sclera. The muscles remain attached in the anatomical positions to the sclera. This method has demonstrated to obtain superior motility results but is not always an option depending on the conditions of each individual case.
Under What Condition Is Eviseration Necessary?
Enucleation/evisceration is most often the last step in the treatment path of the related disorder. The most common reasons for electing this procedure are as follows:
Advanced Intraocular Cancer – Retina blastoma and other malignant tumors of the eyeball. Removal of the eye is often necessary to eliminate the cancer from the body before it spreads or can be treated by other means.
Trauma – Physical injury can damage the delicate structures of the eye beyond the capabilities of modern medical technology.
Painful Blind Eye – enucleation is often requested to relieve chronic persisting pain associated with previous trauma or disease such as advanced glaucoma, corneal and external disease, congenital defects, etc.
Secondary procedure – secondary surgery may be considered as an upgrade to previous anophthalmic surgery.
What Should I Expect During Surgery?
You might want to consider getting a surgery with local anesthesia. The enucleation or evisceration procedure will be followed by the insertion of an orbital implant. These implants are typically spheres 16, 18, 20 or 22mm in diameter. The size will be determined at the time of surgery and is dependent on whether the evisceration or enucleation procedure is performed.
In the case of enucleation, the implant may be wrapped in a donor sclera from an eye bank or alternative bio-resorbable material. This helps ease the implant into position and simplifies the process of reattaching the muscles. The protective outer tissue membrane or conjunctiva is closed over the implant to complete the procedure.
The surgeon may elect to use a conformer. A conformer is a smooth clear piece of plastic placed between the eyelids and the implant. This helps form the proper shape and protect the surgical site during the early stages of the healing process. The use of a conformer is not always necessary and is contingent on the surgeon’s preference and the parameters of the case.
Post Surgery and Follow-Up
The period following surgery is very important. The patient must follow the regimen suggested by the surgeon and his/her support staff. Maintaining a meticulous hygiene program is necessary the next several weeks following surgery. Attention to detail during the healing phase will limit the possibility of exposure and or infection and is the primary responsibility of the patient.
The surgeon will most likely recommend an ocularist who will take over the process of building the cosmetic prosthesis. The prosthesis is like a large hard contact lens that fits over the structure provided by the implant.
Ocularists are skilled artisans that will build the prosthesis to closely resemble the fellow eye to achieve the best possible cosmetic results. Due to the steps necessary build a final prosthesis, a patients relationship with the ocularist is likely to be more extensive than that with the surgeon.