Enucleation of the eye

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Enucleation of the eye
Oculoplastic Surgeon Kami Parsa MD Enucleation.jpg
An oculoplastic surgeon performing an enucleation of the eye.
ICD-9-CM 16.4
MeSH D015353

Enucleation is the removal of the eye that leaves the eye muscles and remaining orbital contents intact. This type of ocular surgery is indicated for a number of ocular tumors, in eyes that have sustained severe trauma, and in eyes that are otherwise blind and painful. [1]

Contents

Self-enucleation or auto-enucleation (oedipism) and other forms of serious self-inflicted eye injury are an extremely rare form of severe self-harm that usually results from mental illnesses involving acute psychosis. [2] The name comes from Oedipus of Greek mythology, who gouged out his own eyes. [3]

Classification

There are three types of eye removal: [4]

Indications

Orbital implants and ocular prostheses

Removal of the eye by enucleation or evisceration can relieve pain and minimize further risk to life and well-being of an individual with the above noted conditions. In addition, procedures to remove the eye should address the resultant appearance of the orbit. Orbital implants and ocular prostheses are used by the surgeon to restore a more natural appearance. [5]

An orbital implant is placed after removal of the eye to restore volume to the eye socket and enhance movement or motility of an ocular prosthesis and eyelids. [5] The eyeball is a slightly elongated sphere with a diameter of approximately 24 millimetres. [6] To avoid a sunken appearance to the eye socket, an implant approximating this volume can be placed into the space of the removed eye, secured, and covered with Tenon's capsule and conjunctiva. [7] Implants can be made of many materials with the most common being hydroxylapatite, metal alloy, [8] acrylic, or glass. [9]

Later, once the conjunctiva have healed and post-operative swelling has subsided, an ocular prosthesis can be placed to provide the appearance of a natural eye. [5] The prosthesis is fabricated by an ocularist. [10] Its form is that of a cupped disc so that it can fit comfortably in the pocket behind the eyelids overlying the conjunctiva that covers the orbital implant. [10] The external portion of the ocular prosthesis is painted and finished to mimic a natural eye color, shape and luster. [8] It can be removed and cleaned periodically by the individual or a care giver. [8]

The two part system of orbital implant and ocular prosthesis provides a stable, and well tolerated aesthetic restoration of the eye socket. [8] Although vision is not restored by removal of the eye with placement of an orbital implant and ocular prosthesis, a natural appearance can result. [5] The implant, along with the attached, visible ocular prosthesis, can be moved by intact extraocular muscles that will track or move simultaneously with the other eye. The eyelids are able to move and blink over the prosthesis as well. [10]

See also

Related Research Articles

<span class="mw-page-title-main">Sclera</span> White part of an eyeball

The sclera, also known as the white of the eye or, in older literature, as the tunica albuginea oculi, is the opaque, fibrous, protective outer layer of the human eye containing mainly collagen and some crucial elastic fiber.

An evisceration is the removal of the eye's contents, leaving the scleral shell and extraocular muscles intact. The procedure is usually performed to reduce pain or improve cosmesis in a blind eye, as in cases of endophthalmitis unresponsive to antibiotics. An ocular prosthetic can be fitted over the eviscerated eye in order to improve cosmesis.

<span class="mw-page-title-main">Orbit (anatomy)</span> Cavity or socket of the skull in which the eye and its appendages are situated

In anatomy, the orbit is the cavity or socket of the skull in which the eye and its appendages are situated. "Orbit" can refer to the bony socket, or it can also be used to imply the contents. In the adult human, the volume of the orbit is 30 millilitres, of which the eye occupies 6.5 ml. The orbital contents comprise the eye, the orbital and retrobulbar fascia, extraocular muscles, cranial nerves II, III, IV, V, and VI, blood vessels, fat, the lacrimal gland with its sac and duct, the eyelids, medial and lateral palpebral ligaments, cheek ligaments, the suspensory ligament, septum, ciliary ganglion and short ciliary nerves.

<span class="mw-page-title-main">Eye surgery</span> Surgery performed on the eye or its adnexa

Eye surgery, also known as ophthalmic surgery or ocular surgery, is surgery performed on the eye or its adnexa. Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.

<span class="mw-page-title-main">Eye injury</span> Physical or chemical injuries of the eye

Physical or chemical injuries of the eye can be a serious threat to vision if not treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye) injuries is redness and pain of the affected eyes. This is not, however, universally true, as tiny metallic projectiles may cause neither symptom. Tiny metallic projectiles should be suspected when a patient reports metal on metal contact, such as with hammering a metal surface. Corneal foreign body is one of the most common preventable occupational hazard. Intraocular foreign bodies do not cause pain because of the lack of nerve endings in the vitreous humour and retina that can transmit pain sensations. As such, general or emergency department doctors should refer cases involving the posterior segment of the eye or intraocular foreign bodies to an ophthalmologist. Ideally, ointment would not be used when referring to an ophthalmologist, since it diminishes the ability to carry out a thorough eye examination.

<span class="mw-page-title-main">Red eye (medicine)</span> Eye that appears red due to illness or injury

A red eye is an eye that appears red due to illness or injury. It is usually injection and prominence of the superficial blood vessels of the conjunctiva, which may be caused by disorders of these or adjacent structures. Conjunctivitis and subconjunctival hemorrhage are two of the less serious but more common causes.

<span class="mw-page-title-main">Exophthalmos</span> Bulging of the eye anteriorly out of the orbit

Exophthalmos is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral or unilateral. Complete or partial dislocation from the orbit is also possible from trauma or swelling of surrounding tissue resulting from trauma.

<span class="mw-page-title-main">Extraocular muscles</span> Seven extrinsic muscles of the human eye

The extraocular muscles, or extrinsic ocular muscles, are the seven extrinsic muscles of the human eye. Six of the extraocular muscles, the four recti muscles, and the superior and inferior oblique muscles, control movement of the eye and the other muscle, the levator palpebrae superioris, controls eyelid elevation. The actions of the six muscles responsible for eye movement depend on the position of the eye at the time of muscle contraction.

<span class="mw-page-title-main">Blepharoplasty</span> Surgical modification of the eyelids

Blepharoplasty is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning of excess tissues, such as skin and adipocyte fat, and the reinforcement of the corresponding muscle and tendon tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the periorbita, which is the area from the eyebrow to the upper portion of the cheek. The procedure is more common among women, who accounted for approximately 85% of blepharoplasty procedures in 2014 in the US and 88% of such procedures in the UK.

Sympathetic ophthalmia (SO), also called spared eye injury, is a diffuse granulomatous inflammation of the uveal layer of both eyes following trauma to one eye. It can leave the affected person completely blind. Symptoms may develop from days to several years after a penetrating eye injury. It typically results from a delayed hypersensitivity reaction.

<span class="mw-page-title-main">Phthisis bulbi</span> Shrunken, non-functional eye

Phthisis bulbi is a shrunken, non-functional eye. It may result from severe eye disease, inflammation or injury, or it may represent a complication of eye surgery. Treatment options include insertion of a prosthesis, which may be preceded by enucleation of the eye.

<span class="mw-page-title-main">Graves' ophthalmopathy</span> Medical condition

Graves’ ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness (erythema), conjunctivitis, and bulging eyes (exophthalmos). It occurs most commonly in individuals with Graves' disease, and less commonly in individuals with Hashimoto's thyroiditis, or in those who are euthyroid.

<span class="mw-page-title-main">Tenon's capsule</span> Membrane surrounding the eye forming a socket in which it moves

Tenon's capsule, also known as the Tenon capsule, fascial sheath of the eyeball or the fascia bulbi, is a thin membrane which envelops the eyeball from the optic nerve to the corneal limbus, separating it from the orbital fat and forming a socket in which it moves.

Oculoplastics, or oculoplastic surgery, includes a wide variety of surgical procedures that deal with the orbit, eyelids, tear ducts, and the face. It also deals with the reconstruction of the eye and associated structures.

<span class="mw-page-title-main">Eye neoplasm</span> Medical condition

Eye neoplasms can affect all parts of the eye, and can be a benign tumor or a malignant tumor (cancer). Eye cancers can be primary or metastatic cancer. The two most common cancers that spread to the eye from another organ are breast cancer and lung cancer. Other less common sites of origin include the prostate, kidney, thyroid, skin, colon and blood or bone marrow.

<span class="mw-page-title-main">Ocular prosthesis</span> Type of craniofacial prosthesis

An ocular prosthesis, artificial eye or glass eye is a type of craniofacial prosthesis that replaces an absent natural eye following an enucleation, evisceration, or orbital exenteration. The prosthesis fits over an orbital implant and under the eyelids. Though often referred to as a glass eye, the ocular prosthesis roughly takes the shape of a convex shell and is made of medical grade plastic acrylic. A few ocular prostheses today are made of cryolite glass. A variant of the ocular prosthesis is a very thin hard shell known as a scleral shell which can be worn over a damaged or eviscerated eye. Makers of ocular prosthetics are known as ocularists. An ocular prosthesis does not provide vision; this would be a visual prosthesis. Someone with an ocular prosthesis is altogether blind on the affected side and has monocular vision.

Osteo-odonto-keratoprosthesis (OOKP), also known as "tooth in eye" surgery, is a medical procedure to restore vision in the most severe cases of corneal and ocular surface patients. It includes removal of a tooth from the patient or a donor.

<span class="mw-page-title-main">Accessory visual structures</span> External parts of the eye including eyebrow, eyelid, and lacrimal apparatus

The accessory visual structures are the protecting and supporting structures (adnexa) of the eye, including the eyebrow, eyelids, and lacrimal apparatus. The eyebrows, eyelids, eyelashes, lacrimal gland and drainage apparatus all play a crucial role with regards to globe protection, lubrication, and minimizing the risk of ocular infection. The adnexal structures also help to keep the cornea moist and clean.

Blast-related ocular trauma comprises a specialized subgroup blast injuries which cause penetrating and blunt force injuries to the eye and its structure. The incidence of ocular trauma due to blast forces has increased dramatically with the introduction of new explosives technology into modern warfare. The availability of these volatile materials, coupled with the tactics of contemporary terrorism, has caused a rise in the number of homemade bombs capable of extreme physical harm.

Ocular surgery may be performed under topical, local or general anesthesia. Local anaesthesia is more preferred because it is economical, easy to perform and the risk involved is less. Local anaesthesia has a rapid onset of action and provides a dilated pupil with low intraocular pressure.

References

  1. "Enucleation". Selected Anomalies and Diseases of the Eye. Texas School for the Blind and Visually Impaired. Archived from the original on 2007-11-25. Retrieved 2007-12-21.
  2. Large, Matthew; Andrews, Doug; Babidge, Nick; Hume, Frank; Nielssen, Olav (1 January 2008). "Self-inflicted eye injuries in first-episode and previously treated psychosis". Australian and New Zealand Journal of Psychiatry. 42 (3): 183–191. doi:10.1080/00048670701827259. PMID   18247192. S2CID   1605060.
  3. Murphy, Mary; Nathan, Malavika; Lee, Edward; Parsons, Brian; Gunasekera, Lal (2006). "Oedipism: Auto-enucleation in a schizophrenic patient" (PDF). Irish Journal of Psychological Medicine. 23 (4): 159–160. doi:10.1017/S0790966700009988. PMID   30290535. S2CID   52923082. Archived from the original (PDF) on 2011-07-22.
  4. "Eye Conditions". Artificial Eye Specialists. Erickson Labs Northwest. Retrieved 2013-02-23.
  5. 1 2 3 4 Alam, Mohammad Khursheed; Bin Jamayet, Nafij; Srithavaj, Theerathavaj (2013). "A Complete Procedure of Ocular Prosthesis: A Case Report". International Medical Journal. 20 (6): 729–730. Retrieved 2023-01-03.
  6. Lemp, Michael A.; Snell, Richard S. (1998). Clinical Anatomy of the Eye. Malden, Massachusetts: Blackwell Science, Inc. p. 136. ISBN   0-632-04344-X.
  7. De Potter, Patrick; Shields, Carol L.; Shields, Jerry A.; Singh, Arun D. (1994). "Problems with the hydroxyapatite orbital implant: experience with 250 consecutive cases" (PDF). British Journal of Ophthalmology . 78 (9): 702–706. doi:10.1136/bjo.78.9.702. PMC   504910 . PMID   7947552 . Retrieved 2023-01-03.
  8. 1 2 3 4 Taylor, Thomas D. (2000). Clinical Maxillofacial Prosthetics. Carol Stream, Illinois: Quintessence Books. p. 265-276. ISBN   0-86715-391-1.
  9. Olver, Jane M; Sagoo, Mandeep S.; Viswanathan (2007). "UK national survey of enucleation, evisceration, and orbital implant trends". British Journal of Ophthalmology . 91 (5): 616–619. doi:10.1136/bjo.2006.103937. PMC   1954760 . PMID   17151061.
  10. 1 2 3 Hughes, Michael O. (2007). "A Pictorial Anatomy of the Human Eye/Anophthalmic Socket: A Review for Ocularists" (PDF). Journal of Ophthalmic Prosthetics: 51-63. Retrieved 2023-01-03.