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Chapter 115 - Enucleation, evisceration, and exenteration

from Section 23 - Ophthalmic Surgery

Published online by Cambridge University Press:  05 September 2013

By
Jill R. Wells ,
G. Baker Hubbard  and
Timothy W. Olsen
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Removal of an eye or the contents of an orbit may be indicated when the eye is affected by neoplasia or a severe infectious process, or when an end-stage ocular disease in a blind eye causes pain. These ophthalmic interventions are usually classified as:

  1. Enucleation: the removal of the entire globe, including the sclera, intraocular contents, and the cornea. The stump of the optic nerve as well as the extraocular muscles are left behind.

  2. Evisceration: the removal of intraocular contents including the lens, uvea, retina, vitreous humor, and in some cases the cornea. Only the sclera and extraocular muscles remain intact.

  3. Exenteration: the removal of the globe and all of the orbital contents. This procedure may include removal of selective sections of orbital bone.

Following enucleations and eviscerations, an orbital implant is used to replace the globe and restore the lost orbital volume. The implant or sphere serves to maintain the structure of the orbit and to provide motility to the overlying prosthesis. For children, it additionally serves to maintain more normal growth of the surrounding orbital bones. In cases of exenteration, an osseointegrated prosthesis may be attached within the orbit, secured with metal support elements or magnets that are attached to bone.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 708 - 710
Publisher: Cambridge University Press
Print publication year: 2013

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References

Dortzbach, RK, Woog, JJ.Choice of procedure: enucleation, evisceration, or prosthetic fitting over globes. Ophthalmology 1985: 92: 1249–55.CrossRefGoogle ScholarPubMed
Kersten, RC, Codere, F, Dailey, RA et al. Orbit, eyelids, and lacrimal system: the anophthalmic socket. Am Acad Ophthalmol BCSC 2006–2007; Section 7: 119–29.Google Scholar
Nerad, JA, Kersten, R, Neuhans, R et al. Orbit, eyelids and lacrimal system. Am Acad Ophthalmol BCSC 1996; Section 7: 116–17.Google Scholar
Nunery, WR, Hetzler, K.Enucleation. In Hornblass, A., ed. Oculoplastic, Orbital, and Reconstructive Surgery. Vol 2. Baltimore, MD: Williams & Wilkins; 1990, pp. 1200–20.Google Scholar
Raflo, TG.Enucleation and evisceration. In Tasman, W, Jaeger, EA, eds. Duane's Ophthalmology. Vol. 5. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.Google Scholar
Soares, JP, Franca, VP.Evisceration and enucleation. Sem Ophthalmol 2010; 25: 94–7.CrossRefGoogle ScholarPubMed

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