Enucleation

Excerpt

Enucleation describes the removal of the entire globe, with separation of all connections from the orbit, including optic nerve transection. It is one of the oldest procedures in ophthalmology, with descriptions dating back to 2600BC. The decision for enucleation can be one of the most difficult to make and discuss with the patient. The main indications for enucleation are trauma, painful eye, a blind eye, which is unsightly, intraocular malignancy, and as part of eye donation. Alternatives such as evisceration or exenteration can be considered according to the underlying diagnosis and condition of the eye.

Management of the anophthalmic socket is challenging, and a decision on implant selection and wrapping material should ideally be made as part of the pre-operative plan. Wrapping materials can be synthetic, autologous, or human tissue sourced from an eye bank. Some patients can benefit from a peg placement for improved postoperative motility and cosmesis. However, this procedure has been largely abandoned because of the occurrence of late complications, including infections, exposure, discharge, and peg loss. Ultimately, the aims of enucleation are to remove diseased tissue, improve patient comfort, replace orbital volume, and give a good functional and cosmetic result for the patient.