Evisceration: Don't be afraid, let's talk about it

The thought of having your eye completely removed makes you shudder, doesn't it? It's hard to imagine. But sometimes, due to unbearable pain, severe infection, or a serious accident, your eye can be saved. This is when doctors talk about the surgery called 'Evisceration'. Even though the name may sound scary, once you know exactly what it is and why it's being done, your fear will go away. So let's talk about it in detail.

Simply put, what is Evisceration?

Evisceration is not a surgical procedure that completely removes the eye. It involves surgically removing only the contents of your eye. However, the white part of the eye, the sclera , and the muscles that move the eye are left intact.

Think about a coconut. When we grate a coconut, we remove only the kernel and leave the coconut shell, right? That's what happens here too. We remove the inside parts of the kernel, leaving the outer "shell" of the kernel.

After removing the inside of the eye in this way, the doctor inserts a special ball-like implant into the empty space. This helps to maintain the natural shape of the eye. Then, once you have healed well, you can have a prosthetic eye that looks very natural if you wish. This is a very delicate, colored eye that looks exactly like your other eye.

Why do you need to have this kind of surgery?

A doctor will only recommend this type of surgery when there is no other option and it is absolutely necessary. This is usually due to the following reasons:

• Severe eye infections (endophthalmitis): Sometimes, a very serious infection can develop inside the eye. If these cannot be controlled with regular antibiotics , the infection can spread throughout the eye and even into the brain. In such cases, this surgery is performed to remove the infected parts.
• Serious eye injuries: When something sharp goes into the eye and causes serious damage, the eye may not be able to be saved.
• A blind and painful eye: Some medical conditions can cause complete loss of vision. However, if there is unbearable and persistent pain, this surgery is the best solution to get rid of that pain.
• Shrinkage of the eye ( Phthisis bulbi ): This is also known as 'end-stage eye'. This is when the eye gradually shrinks, becomes inactive, and changes in appearance. This surgery is used to relieve the pain and change in appearance in this condition.

How do you prepare before surgery?

It is very important to prepare yourself well before a surgery like this.

1. Meeting with the Ocularist: Before the surgery, it is a good idea to meet and talk to the specialist who will make your artificial eye (Ocularist). This way, he can carefully observe things like the color and shape of your other eye and take the necessary measurements for the artificial eye that will be made later.

2. Talking to your doctor: You should tell your doctor about all the medications you take, even vitamins. Especially if you are taking anticoagulants , your doctor will advise you how many days before the surgery you should stop taking them. Never stop taking any medication without asking your doctor.

3. Fasting: The day before surgery, you should stop eating and drinking for as long as your doctor tells you. This is usually 6-8 hours before surgery.

4. Someone to take you home: This surgery is usually an outpatient procedure, so you can go home the same day. However, since you are under anesthesia , you will not be able to drive or go home alone. You will definitely need a family member or friend to take you home.

How the surgery is performed

This surgery usually takes about an hour or two. After you are taken to the operating room, you will be given general anesthesia, or local anesthesia, and medicine to help you relax.

The doctor carefully removes the inside of the eye, leaving the white outer layer (sclera) and muscle intact. Then, the ball-like implant is inserted to maintain the shape of the eye.

After surgery, a temporary plastic flap called a conformer is placed to keep the space between the eyelids in place and to create a better fit for the artificial eye that will be inserted later. Sometimes, the doctor may temporarily close the eyelids with stitches. Finally, a pressure bandage is applied to the eye to stop bleeding and reduce swelling.

What happens after the surgery?

After the surgery, you will be given some time to rest and then allowed to go home after you wake up from the anesthesia. Here are some things to keep in mind after you go home:

• Painkillers and antibiotics: Your doctor will prescribe pain medication and antibiotics or steroids to prevent infection. Take these medications exactly as prescribed.
• Bandage: Do not remove the bandage until your doctor tells you to. Be careful not to get it wet. It is usually removed within a day or at the next clinic appointment (follow-up appointment).
• Work restrictions:
• Avoid strenuous activities such as swimming, running, jumping, or playing sports for at least two weeks, possibly four weeks .
• Avoid bending from the waist down and lifting weights greater than 5-10 kg for four weeks .
• Re-examination: You will usually be asked to come back in about a week. At that time, the bandage will be removed and your eye will be examined.
• Implantation of the artificial eye: Once the tissues inside the eye have healed well, which is usually after 6-8 weeks , you can have the artificial eye implanted. Your doctor will let you know to schedule an appointment for this.

Benefits and possible risks of surgery

Like any surgery, it has benefits and some risks, which are important to be aware of.

What is the difference between Evisceration and Enucleation?

You may have heard of another surgery called enucleation. Although both are eye surgeries, there is a big difference between the two.

When to call your doctor

If you experience any of these symptoms after going home after surgery, call your doctor immediately :

• If there is excessive bleeding .
• If you experience unbearable pain in your eyes or head, even after taking painkillers.
• If there is a pus-like fluid coming out of the eye, or if you have a fever (these could be signs of an infection ).
• If the other eye that did not have surgery feels pain .

I understand how scary it can be to hear about this kind of surgery. But remember, a doctor will only suggest something like this if they feel it is the best solution to a life-threatening or excruciatingly painful condition. Talk to your doctor about all your concerns and fears. They will give you all the information and support you need.