When a Doctor advises an eye removal the patients always get shocked and worries about what the operation involves and their appearance after the eye removal. These are normal reactions and I hope that the information below will help to answer some of these anxieties.
Reasons for Removal of an Eye
The eye needs removal because
§ It is blind and painful.
§ It has developed some Tumours (malignant).
§ After a severe injury.
§ No vision potential
§ Chance of sympathetic ophthalmia
The answer is that an eye removing operation is not recommended lightly and undertaken only when all other treatments are ineffective, inappropriate or undesirable.
It is the final measure, taken in the best interest of the patient, by the Ophthalmologist (an eye doctor) after a great deal of consideration and consultation with patients, parents and if required with other Ophthalmologists.
Patient is usually admitted to the hospital one day before the surgery for tests to check their health because the operation involves having a general anaesthetic. General anaesthetic is administered to the patient for this operation so the patient will be asleep during the procedure that takes about an hour.
Before the operation the patient will be asked to sign a consent form for this surgery which is a necessary.
Enucleation is the surgical removal of the globe (eyeball) only. The eyelids, brow and surrounding skin are all left intact.
The eyeball is removed by incising and preserving the conjunctiva and detaching the muscles from the eyeball, the optic nerve is severed.
An implant such as a plastic ball, Hydroxyapatite ball or Medpore ball may be sutured into the socket (space left by the eyeball), the muscles are re-attached around this and then it is covered with conjunctiva (the mucous membrane which lines the inner surface of the eyelids and stretches over the white part of the eye and the cornea, the coloured part of the eye), which is sutured together over the implant to give the socket a moist and pink look. A conformer (a clear plastic shell) is put in place behind the lids. This gives some shape while the socket heals. The operated eye will be covered with a pressure pad and dressing for 12 to 48 hours. During this time the patient may experience difficulty in opening the lids of the un-operated eye. This can be frightening because it means that the patient may not be able to see at all, but it only lasts while the pad is in its place. The pad is intended to reduce swelling of the tissue in the socket. As the anaesthetic wears off the patient may feel some pain in the socket or have some sickness that can be relieved with medicine. Normal activities can be resumed as soon as the patient feels fit for it.
When the eye pad is removed, the nurse caring for you will clean your lids and the Ophthalmologist will examine the patient’s eye socket with a torch and prescribe eye drops or ointment.
The eyelids may be swollen and bruised for a few days. The patient may be asked to use dark glasses till the swelling subsides. The socket is left unpadded to promote healing.
Initially when the patient opens eyelids the patient may see the moist, pink socket lined with conjunctiva. If there is a conformer (shell) in place the patient will see the clear plastic with a hole in the centre. The shell is only there temporarily until the socket heals and stock artificial eye or a custom-made artificial eye can be fitted. Usually it takes six weeks before the custom-made artificial eye can be fitted.
In case of the patient being a child of less than two years age. Only enucleation is performed and non absorbable sutures are placed on the four rectus muscles so that they can be identified afterwards for putting the motility implant when the child is a little older.
Patients are taught, by the nursing staff, to look after themselves and the eye as soon as possible. Patients are advised to stay in the hospital till they are confident that they can take care of themselves, usually a few days. In some circumstances, family and friends are taught, so that they can help the patient.
Initially the patient may need to clean the lids with cool, boiled water to remove any mucous. If this mucous becomes excessive or discoloured the patient should see the Ophthalmologist.
Hands should always be washed thoroughly before touching the operated area and it is advisable not to touch the socket. The patient may need to wash the shell, initially twice a day with soap and water. Rinsing thoroughly to ensure that no soap remains on the shell and replace it. Patient can wash the face normally.
If the shell falls out on its own, which is rare, clean it thoroughly with soap and water and rinse it thoroughly before replacing it.
For the first few weeks the patient has to put eye drops to prevent infection. The patient need not remove the shell or artificial eye to instil eye drops or ointment.
Ophthalmologist refers the patient to an Ocularist for fitting of artificial eye.
The Ocularist will decide when to give a custom-made prosthesis. This involves the moulding of patients eye socket using impression material (a painless procedure) and hand painting of the eye colour. The eye shape, size and colour are made to match the good eye so that it is difficult to tell them apart.
There should be an adequate range of eye movements of the artificial eye if it is custom made. The prosthesis can be worn without removing for days together. It can be worn during sleeping hours as well. The discharge is reduced if it is custom-made artificial eye (prosthesis).
The patient can wear eye make-up once the socket is healed completely.
Patient is advised to wear goggles when swimming and remove the artificial eye if diving or water skiing to prevent loss.
It is necessary to wear protective goggles when doing anything that may cause injury to the remaining good eye.