An enucleation is the surgical removal of an eye. During the operation, your eye will be replaced by an implant, which will fill the socket and help to achieve a good cosmetic result when you are fitted with your artificial eye.
What are the benefits of having an Enucleation?
An enucleation eliminates the tumour when it is not possible to conserve a comfortable and seeing eye. It also prevents the tumour from spreading from the eye if it has not already done so.
What are the risks of having an Enucleation?
There is a small risk that the ball implant will become exposed and infected. This would require further surgery. There is usually some drooping of the upper eyelid but this does not tend to be troublesome.
The lower lid may sag from the weight of the artificial eye and this may require corrective surgery, which is performed under local anaesthetic.
What will happen if I don’t have any treatment?
Your tumour may continue to grow. This might make treatment more difficult and could make the eye painful. There may be an increased risk of tumour spread out of the eye and to other parts of the body.
What sort of anaesthetic will be given to me?
The operation is usually performed under general anaesthetic. A local anaesthetic block is administered during the operation to assist with post-operative pain control.
You will be given an opportunity to discuss anaesthetic risks with your anaesthetist before your surgery.
If you are worried about any of these risks, please let us know before you are due to have this treatment.
Getting ready for your operation
The operation is usually performed as a day procedure, which means you will go home on the same day. We will give you the exact admission time and paperwork required. Each medical aid requires pre-authorization. You willreceive a document with the procedure codes and hospital. When you contact your medical aid, they will issue you with an authorization number for he procedure. You must obtain an authorization number prior to the procedure.
The day of your operation
You may not eat or drink anything for 6 hours prior to the procedure
Do not wear any make up or facial products for at least 2 days prior to surgery
You will be admitted via the day ward on the day of your operation.
You will be asked to remove jewelry – band rings can be worn but they will be taped.
If you are on regular medication, you should take this on the day of the operation. The only exception is diabetic medication this should not be taken as you will not be eating for 6 hours prior to surgery
A bracelet with your personal details will be attached to your wrist.
You will be asked to sign a consent form.
A nurse and porters will take you to the operating theatre.
Your dentures, glasses or hearing aid can stay with you on your journey to the operating theatre.
The operation to remove your eye takes approximately one hour. Once your eye is removed, an implant will be inserted into the space.
The muscles that were attached to your eye will be reattached to your implant. This will give some movement of the prosthesis along with your unaffected eye, giving a better cosmetic effect.
Your implant will not be visible, and your tissues will be closed over the implant, which normally stays in the socket permanently.
A temporary prosthesis or clear conformer will be placed in the socket (over the top of your implant and surgical wound) at the end of the operation or soon after.
This helps your wound heal in the correct shape, and makes fitting of your permanent artificial eye, at a later date, much more effective. For this reason, it is important to wear your conformer or prosthesis as much as possible.
Once healed, the conjunctiva, which is the transparent tissue which covers the outer surface of the eye and the inner surface of the lids, will look similar to the skin on the inside of your lip.
Your tear function will not be affected, and you will be able to open and close your eyelids as normal.
During the operation, you will be given an injection of local anaesthetic. This is usually effective in relieving pain for the first 6 hours after your operation. After this, any pain is usually minimal and can be helped by painkillers.
What should I expect after my operation?
After your operation you will be kept in the theatre recovery room be fore being transferred to the ward.
You will have a pad and shield over the operated eye.
The socket might be red and possibly a little swollen for a couple of weeks, but this will settle.
You may see colours and other images from the side of your enucleation (i.e.,„phantom eye‟). This symptom resolves spontaneously and is not worrying.
You are usually discharged on the same day of the operation.
Pain relief and medication
o The nursing staff will advise you about painkillers before you leave the hospital.
o Continue any oral medication prescribed by the doctors.
o Remember to wash your hands both before and after applying eye drops.
o Avoid rubbing or pressing your eye for two to three weeks after the operation. Keep the socket clean and avoid touching the area with anything that might cause an infection.
Getting back to normal
You may feel low in mood at times after you have been discharged from hospital. If you would like to see a counsellor, please let us know.
Returning to work
You will be booked off work for 2 weeks. If you require additional time, this will be assessed and discussed with you on your first post-operative visit.
Your first visit will be 2 weeks after your operation.
About six to ten weeks after your operation, you will be sent to see an ocular prosthesist, who will examine you and discuss the design and manufacturing of your artificial eye.
This six to ten week time delay is ideal, as it allows the tissues in your eye socket to have settled down and means that the permanent artificial eye will be the best fit possible.
In some cases, post enucleation socket syndrome can occur. In this, the upper eyelid can droop and the prosthesis may sit further back into the socket. Sometimes the prosthesis slips out over your lower eyelid. Should they occur, these problems can be discussed and addressed with an additional minor procedure.