Evisceration of the eye is a surgical procedure performed to remove the inner contents of the eye, leaving the outer shell or sclera intact. This is typically done when the eye has become non-functional, is painful, or poses a risk of infection. Evisceration differs from enucleation, where the entire eyeball is removed, and exenteration, which involves removing the entire orbital contents, including muscles and surrounding tissue.

This procedure is often necessary for patients who have lost vision due to trauma, infection, or diseases that render the eye irreparably damaged. The primary goal of evisceration is to relieve pain, prevent infection, and prepare the eye for the placement of an ocular prosthesis, improving the patient’s quality of life.

There are several situations where evisceration may be recommended:

• Severe Trauma: When the eye has suffered severe trauma, such as from a penetrating injury, explosion, or accident, that leads to blindness and chronic pain, evisceration may be necessary. This can prevent complications like sympathetic ophthalmia, a condition in which the immune system attacks the healthy eye in response to the injured one.
• Infection: In cases of uncontrolled eye infections, such as endophthalmitis (infection within the eye), evisceration may be needed to control the infection and prevent it from spreading to other parts of the body, especially when vision cannot be salvaged.
• Intractable Pain: Chronic, unmanageable eye pain, often seen in blind or disfigured eyes, can significantly reduce the quality of life. Evisceration is performed to alleviate this pain while preserving the outer appearance of the eye socket.
• Tumors: Evisceration may be necessary in some cases of intraocular tumors, where the removal of the eye’s inner contents can help control the spread of malignancy.

It is crucial to understand the difference between evisceration and enucleation, as both procedures are used to address different eye conditions:

• Evisceration: In this procedure, only the inner contents of the eye (the uvea, retina, and vitreous) are removed, while the sclera and extraocular muscles remain intact. It is less invasive than enucleation and offers better cosmetic outcomes since the eye socket retains its natural shape.
• Enucleation: This involves the complete removal of the eyeball, including the sclera. It is often performed when tumors are present in the eye, or when the entire eye is severely damaged beyond repair. Since the eye is entirely removed, enucleation results in a more profound alteration in the appearance of the eye socket.

Both procedures are performed under similar circumstances, but evisceration is typically preferred for cosmetic reasons when there is no risk of tumor spread or other complications requiring enucleation.

Evisceration is typically performed under general or local anesthesia, depending on the patient’s health and preferences. The key steps of the procedure include:

1. Incision: A small incision is made in the cornea or sclera to gain access to the internal structures of the eye.
2. Removal of Internal Contents: The contents of the eye, including the uvea, retina, and vitreous, are carefully removed through the incision. Care is taken to preserve the sclera and extraocular muscles, which will support the prosthesis later.
3. Insertion of an Implant: Once the eye’s contents are removed, an orbital implant made from silicone, hydroxyapatite, or other biocompatible materials is placed into the scleral shell. This implant helps maintain the eye’s natural shape and allows for better cosmetic results.
4. Closure: The scleral shell and conjunctiva are closed over the implant, ensuring a smooth surface for the subsequent fitting of a prosthetic eye.

The surgery typically takes one to two hours, and patients can usually return home the same day.

After evisceration, patients will need to follow specific guidelines to ensure proper healing and to prepare for the fitting of a prosthetic eye:

• Pain Management: Mild discomfort is common after the procedure. Pain medications are prescribed to manage postoperative pain, and antibiotics may be given to prevent infection.
• Bandaging: The eye will be bandaged for several days to protect the surgical site and reduce swelling. Patients should avoid rubbing the eye or getting the area wet during this time.
• Follow-up Appointments: Several follow-up appointments will be necessary to monitor healing and ensure there are no complications. The surgeon will assess the implant and ensure proper healing before referring the patient for prosthesis fitting.
• Prosthesis Fitting: Approximately four to six weeks after surgery, once the area has fully healed, a custom-made prosthetic eye is fitted. The prosthesis is designed to match the color and appearance of the patient’s natural eye, providing excellent cosmetic results.

As with any surgical procedure, evisceration carries some risks. Potential complications include:

• Infection: Although rare, infection can occur postoperatively. Patients are monitored closely and prescribed antibiotics to minimize this risk.
• Implant Extrusion: In some cases, the orbital implant may become dislodged or extruded, requiring additional surgery.
• Bleeding or Swelling: Postoperative bleeding or swelling can occur but is usually manageable with proper care.
• Sympathetic Ophthalmia: Although rare, this condition, in which the immune system attacks the remaining eye, can occur even after evisceration. Regular follow-up is essential to monitor for this complication.

Losing an eye, even a non-functional one, can be emotionally challenging for patients. However, evisceration with the placement of an orbital implant and a prosthetic eye offers excellent cosmetic results. Most patients report a significant improvement in self-esteem and appearance after receiving a well-fitted prosthesis.

Psychological support may also be necessary for some individuals, especially if the loss of the eye was due to trauma or illness. Support groups, counseling, and education on living with a prosthetic eye can aid in the emotional adjustment.

Evisceration of the eye is a vital procedure for individuals suffering from painful, blind, or infected eyes. It not only helps relieve pain and prevent further complications but also provides an excellent cosmetic outcome with the use of modern implants and prosthetics. With proper care and rehabilitation, most patients can resume their normal activities and enjoy a high quality of life post-surgery.

World Eye Care Foundation’s eyecare.live brings you the latest information from various industry sources and experts in eye health and vision care. Please consult with your eye care provider for more general information and specific eye conditions. We do not provide any medical advice, suggestions or recommendations in any health conditions.