ENUCLEATION

It is the removal of the entire eye and part of the optic nerve Indication – Severe injury resulting in uveal tissue prolapse Loss of perception An irritated, blind, painful, deformed or disfigured eye usually caused by extreme glaucoma, retinal detachment An eye without useful vision Intra ocular tumors that is untreatable by other means

The procedure involves Separation and cutting of each of the ocular muscles Dissection of the tenon’s capsule (fibrous membrane covering the sclera) Cutting of the optic nerve form the eyeball Insertion of an orbital implant A large pressure dressing is applied over the area

Evisceration Surgical removal of the intraocular contents through an incision or opening in the cornea or sclera Indications Ocular trauma with ruptured globe Severe ocular inflammation or infection

The optic nerve, sclera, extraocular muscles and sometimes the cornea are left intact Advantage of evisceration over enucleation is that final cosmetic result and motility after fitting the ocular prosthesis are enhanced

Exenteration Removal of the eyelids, the eye, and various amounts of orbital contents Indications Malignancies in the orbit that are life threatening All other surgical management is not possible Ex- squamous cell carcinoma of paranasal sinuses, skin and conjunctiva with deep orbital involvement

In most extensive cases it include removal of all orbital tissues and resection of the orbital bones.

Ocular prostheses Orbital implants and conformers (ocular prostheses usually made of silicone rubber) This maintains the shape of the eye after enucleation and evisceration to prevent a contracted, sunken appearance This will protect suture line, maintain the fornics and promote integrity of the eyelids.

Ocular prosthetics have limitations in their motility Two designs of eye prostheses Anophthalmic ocular prostheses Scleral shells

Eye prosthesis usually lasts about 6 years When the socket is completely healed, the doctors refer them to ocularist (specially trained and skilled professional who makes eye prostheses)

Light weight orbital prosthesis with or without specs

Management Removal of eye have physical, social and psychological problems for patients The patients preparation should include information about the surgical procedure and placement of orbital implants and conformers Availability of ocular prosthetics

Teaching about post surgical and prosthetic care Inform them there will be large ocular pressure dressing – typically removed after a week Ophthalmic topical antibiotic ointment applied in the socket three times daily Take extra caution in their ambulation and movement to avoid injury Inform that conformers may accidentally fall out of the socket. If this happens, the conformer must be washed, wiped dry, and place back in the socket

Self care teaching Teach how to insert, remove and care the prosthetic eye Proper hand hygiene must be obtain before inserting and removing ocular prosthesis A suction cup can be used to remove the prosthesis Avoid falling of prosthesis in the floor When instructing – a return demonstration is important to assess the level of understanding

Hygiene and comfort is mandatory Daily irrigation of the prosthesis with normal saline, contact lens solution or artificial tears Removing crusting and mucous discharge that accumulate over night is performed with the prosthesis in place. Malpostion can occur while wiping or rubbing Use a clean finger to reposition it Sometimes lubrications is used - irritation

Inspect socket daily for any infections or secretions Any unusual discomfort, irritation or redness should be reported