enucleation

Enucleation is the surgical removal of the eyeball (the globe) while preserving the surrounding orbital tissues. The procedure is performed under general anesthesia and is typically followed by placement of an orbital implant to maintain facial volume and a prosthetic eye. Enucleation is distinct from evisceration, which removes the intraocular contents but leaves the sclera and extraocular muscles intact, and from exenteration, which removes the entire contents of the orbit, including the eyelids.

Indications for enucleation include malignant intraocular tumors such as retinoblastoma in children or choroidal melanoma in adults; severe, irreparable trauma or infection of the eye; a painful blind eye; and certain cosmetic or functional considerations when the eye cannot be preserved.

The procedure generally involves removing the globe along with the optic nerve while preserving surrounding orbital tissues, detaching the extraocular muscles from the globe and reattaching them to an orbital implant to provide a semblance of motility to a subsequent prosthetic eye, and closing the conjunctiva around the implant. A space is created for the implant, and after healing, a surgically fitted ocular prosthesis is placed to match the appearance of the other eye. Implants may be silicon, porous silicone, or other biocompatible materials, and may allow tissue integration to varying degrees.

Postoperative care includes pain management, antibiotics to reduce infection risk, and wound care. A prosthetic eye is typically fitted several weeks after healing. Complications can include infection, implant exposure or migration, socket contracture, and, rarely, sympathetic ophthalmia. Enucleation is aimed at preserving cosmesis and socket integrity while removing the diseased or nonfunctional eye.