Evisceration - Let's talk about this

It is normal for anyone to feel a great sense of fear and shock when they hear the word "eye removal." But sometimes, to relieve unbearable pain, control a dangerous infection, or after a serious accident, eye surgery is necessary. But not always the entire eye is removed. Today we are talking about a special surgery that removes only the contents of the eye, leaving the sclera (what we call the "white part of the eye") and the muscles that move the eye. This is what is called "Evisceration" in medical terms.

Why is it necessary to have this kind of surgery?

This is not something that is done lightly. A doctor will only recommend this type of surgery in ވަ specific and serious cases. Think about these situations:

• Severe eye infections: Sometimes a very serious infection can develop inside the eye. This is called ``Endophthalmitis.'' If this infection cannot be controlled with medication, it can spread not only to the eye but also to the brain, causing life-threatening complications. In such cases, surgery is performed to remove the infected parts.
• Serious eye injuries: If something sharp sticks into the eye and damages it deeply, it may not be able to be repaired. It can also cause unbearable pain.
• A blind and painful eye: Some medical conditions can lead to complete loss of vision. It's okay to lose your vision, but if you're experiencing persistent, unbearable pain, this is the best solution to get rid of that pain.
• Phthisis bulbi: This is a condition in which the eye gradually shrinks and becomes inactive. This condition can also cause pain and problems with vision.

How do you prepare before surgery?

Since this is a planned surgery, you will have time to prepare in advance.

1. Meeting with an Ophthalmologist: After surgery, you will need a prosthetic eye. The specialist who makes these is called an Ocularist. It is very important to meet with him or her before the surgery. He or she can then plan a prosthetic eye that will fit your other eye and look as natural as possible. This is like a thick contact lens that you put on your eye.

2. Talking to your doctor: You should tell your doctor about all the medications you take, even vitamins. Especially if you are taking anything like anticoagulants , your doctor will tell you how many days before the surgery you need to stop taking them.

3. Other things: The day before your surgery, you will be instructed on what time you should stop eating and drinking. Also, arrange for a family member or trusted friend to drive you home after the surgery. Since this is often an outpatient procedure, you can go home the same day, but you will not be able to drive.

What happens during the surgery?

This surgery is done in an operating room. You may be given general anesthesia or local anesthesia to numb your eye and make you feel comfortable.

The surgeon carefully removes the contents of the eye (the cornea, the lens, and the jelly-like substance inside the eye). However , the white part of the eye (sclera) and the muscles around the eye that move the eye back and forth are left intact.

Then, a small ball-shaped implant is inserted into the empty space to help maintain the shape of the eye. A temporary plastic conformer is placed over the implant. This helps to keep the space inside the eyelid the same. This makes it easier to insert the artificial eye later. Sometimes, the eyelids may be stitched shut until the wound heals. Finally, a pressure bandage is applied to the eye to stop bleeding and reduce swelling. The entire procedure usually takes about an hour or two.

What should I do after the surgery?

To make your recovery period successful, it is very important to follow the doctor's instructions exactly.

• You will be prescribed painkillers, antibiotics to prevent infection, and steroids to reduce swelling. Take them exactly as prescribed.
• Do not remove the bandage on your eye until your doctor tells you to (usually on the first day or until you return to the clinic). It is also important to take care not to let it get wet.
• Avoid swimming, running, or jumping for at least two weeks, possibly four weeks.
• Stop bending from the waist down and lifting weights for four weeks.
• You will be asked to come back to see the doctor for a follow-up in about a week.
• Once the wounds have healed well, which means after about 6 to 8 weeks, you can visit your Ocularist and have a permanent artificial eye fitted.

What is the difference between Evisceration and Enucleation?

Both are eye removal surgeries, but there is a slight difference. In `Evisceration`, the outer layer of the eye (sclera) and muscles are left. In `Enucleation` , the entire eyeball and part of the optic nerve are removed. `Enucleation` is often performed if there is something inside the eye, such as cancer.

When should you seek immediate medical advice?

It is normal to have some mild pain and swelling after surgery. However, if you experience these symptoms , call your doctor immediately or go to the nearest hospital's Emergency Department (ETU).

• If there is excessive bleeding .
• If you experience severe pain in your eyes or head that cannot be controlled even with painkillers.
• If you see signs of infection such as fever and pus .
• Most importantly: If there is pain or vision changes in the other healthy eye (this may be a sign of a condition called `Sympathetic ophthalmia`, prompt treatment is essential).

It's natural to feel scared when you hear about this type of surgery. But remember, this is being done as the best option to save your life, relieve you of severe pain, or prevent further complications. Discuss all your concerns and fears with your doctor. It's your right.

Eye removal, Eye surgery, Evisceration, Enucleation, Artificial eye, Eye infection, Endophthalmitis