Hearing about having your entire eye surgically removed can be scary, shocking, and even sad. This is a very sensitive topic. Your doctor may have talked to you or a family member about this type of surgery. At that time, you may have many questions. It's normal to think things like, "Why do I need to do this?", "What will happen after this?", "How will I cope with life?" So don't be afraid. Let's talk about this very simply, in a way that you can understand, as if you were talking to a close friend.
Simply put, what is "enucleation"?
This is a complicated word, but its meaning is very simple. "Enucleation" refers to the surgical removal of your entire eye globe, the part of the eye that we see, along with a small portion of the optic nerve that connects it and carries messages to the brain.
But the most important and comforting thing here is that the muscles around your eye that help you move your eye back and forth (eye muscles) are not removed . The surgeon leaves those muscles intact. This is very important. Because, when you later get a prosthetic eye, those muscles can be connected to the new eye. Then the prosthetic eye will move with the other eye to some extent. It will give a very natural look.
Why is it necessary to have this kind of surgery?
It's not easy for a doctor to make such a big decision. When all other possible treatments have been tried and none of them have yielded successful results, this surgery is suggested as a last resort. Just think, sometimes this surgery can even save someone's life.
There are several main reasons for performing this surgery. Let's take a look at what they are.
| Main reason | A simple explanation |
|---|---|
| Traumatic eye injuries | In cases where the eye has been severely damaged, causing complete loss of vision, and there is no way to restore it, it can continue to cause pain and infection. |
| Eye cancers | Especially in cases of cancer such as intraocular melanoma in adults and retinoblastoma in young children (under 3 years of age), removing the eye is essential to stop the cancer from spreading to other parts of the body. |
| Severe infections | Severe infections that cannot be controlled with medication and that destroy the eye. For example, conditions like Acanthamoeba Keratitis and Endophthalmitis . These infections can be life-threatening if they spread to the brain. |
| Painful blind eye | Some people have complete loss of vision but continue to have unbearable pain in that eye. Or if the appearance of the eye has changed (e.g., a condition in which the eye shrinks (Phthisis Bulbi) ) and it causes great psychological distress, this surgery is performed to relieve the pain and psychological distress. |
| Other special reasons | Rare conditions such as Sympathetic Ophthalmia . In this, when one eye is damaged, the body's immune system mistakenly starts attacking the healthy eye as well. The damaged eye has to be removed to save the healthy eye. This surgery is also performed in cases where the eyes are born very small (Microphthalmia) . |
The most important thing is that this surgery is done to relieve your pain, save you from a life-threatening illness, and allow you to live a normal life again.
What should you do before surgery?
Your surgeon and anesthesiologist will talk to you before the surgery and explain everything. Don't be afraid to ask any questions you have at that time.
- Food and Drink: Often, you will be asked to stop eating and drinking completely after midnight the night before surgery.
- Tell your doctor about any medications you are taking, including vitamins and herbal remedies. If you are taking blood thinners (anticoagulants), you may be asked to stop taking them a few days before your surgery.
- Talk about the prosthetic eye: If you will be getting a prosthetic eye after surgery, talk to your doctor beforehand about what to do after the procedure and how to care for it.
- Someone to support you: You should have someone responsible for taking you home after surgery. It would be great if you had someone with you the first night.
How is the surgery done?
This surgery is not very complicated and usually takes about an hour.
1. Anesthesia: Most of the time, this is done by putting you under general anesthesia. This means you are completely asleep and you don't feel anything. In some special cases, this can be done by numbing only the area (local anesthesia) and giving you medicine to help you sleep lightly.
2. Removing the eye: The doctor carefully separates the eyeball from the surrounding tissue and muscles and removes it.
3. Placing the implant: A spherical implant, similar to a marble, is inserted into the empty space where the eye was removed. This fills the space inside and helps give a natural shape to the area where the eye used to be.
4. Muscle attachment: Next, the previously saved eye muscles are attached to the newly placed implant and sewn in. This implant is covered with tissue similar to the white part of the eye (the `sclera`).
5. Placing a temporary cover: Next, a thin plastic cover called a ``conformer`` is placed over the implant. This is to protect the space needed to insert the artificial eye later.
6. A bandage for protection: Finally, a large pressure bandage is placed over the wound to protect it and control swelling and bleeding. Sometimes the eyelid may be temporarily sewn shut until the wound heals.
How should I take care of myself after the surgery?
After the surgery, you will be kept in a recovery room for a while and then allowed to go home when everything is confirmed to be fine.
- Pain: There may be some pain for the first 3-5 days. Use the painkillers prescribed by your doctor as directed. Most people can control this with over-the-counter painkillers.
- The bandage: Do not remove the heavy bandage until your doctor tells you to. It is usually removed at your follow-up visit in about a week. Until then, you should take care not to let it get wet .
- Medication: Use antibiotics exactly as prescribed to prevent infection. You may also be given eye drops.
- Rest: Avoid strenuous activity, lifting weights, or bending over for 2-4 weeks. Give your body time to heal.
- Artificial eye: Once the wound has fully healed, usually in about 6-8 weeks, you will be referred to an eye specialist (ocularist). He or she will create a very natural-looking artificial eye that matches the color and size of your other eye.
Are there any risks to this surgery?
As with any surgery, there are some very small risks involved, but these are rare.
- Bleeding
- Infections
- Scarring
- Eyelid problems (e.g., drooping eyelid - `ptosis`)
- Extrusion of the implant
If something like this happens, it can be treated, so don't worry about it.
When you need to talk to the doctor!
It's important to pay attention to your body during your recovery. If you experience any of the symptoms below, call your doctor right away.
| Emergencies - take care of these | |
|---|---|
| Fever | If your body temperature rises, it could be a sign of an infection. |
| Severe pain | If you have severe pain in your head or eye area that doesn't go away even after taking painkillers. |
| Pus discharge | If the wound is oozing a thick yellow or green fluid (pus) or has a bad odor. |
| Removing the implant | If the implant or 'conformer' that was inserted comes out. |
| Vomiting and nausea | If you are vomiting continuously or have nausea. |
Take-Home Message
- Making the decision to have an eye removed is a very difficult and painful experience for you and your family. It's normal to have those feelings.
- This surgery is often performed as a last resort, when there are no other options. It can relieve chronic pain, cure serious diseases like cancer, and even save lives.
- If you need emotional support during your recovery, talk to your doctor or a loved one about it. If necessary, you can seek counseling or support groups with people who have had similar experiences.
- After getting an artificial eye, most people have a very natural look, so you can go about your normal life with confidence again.
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