Enucleation

This information is designed to help you understand the basics of an enucleation or removal of an eye. The surgery and artificial eye implant are explained. It is not written to help you make the decision whether or not to have an eye removed, but to let you know what to expect after the enucleation has been performed. 

If you have any questions while reading this, please ask one of the nurses to assist you. Enucleation of the eye means that the eye ball is removed surgically, leaving the surrounding muscles and tissues within the eye socket. In most cases, the eye ball is replaced with a small ball that provides body within the eye socket. The muscles and other soft tissues are sewn in place around or to this small ball to hold it in place and provide some movement to it. This ball may be glass, silicone rubber, or plastic. Because this is not a natural part of the eye socket, this ball is a “foreign body” in the eye socket, and though rare, it is always possible that it could be forced out of the eye socket. In the great majority of patients, this ball is tolerated well and without problems of any sort. 

Because the tissues around this ball must be in excellent condition to make sure the surgery is successful, great care should be taken not to disturb or irritate the skin or area around the eye socket. At the time of surgery, a plastic or silicone shell (conformer) is placed over the ball in the eye socket and between the eyelids in order to help keep the eye shape of the area inside the eye socket, and keep the eye lids from shrinking. Once the area inside the eye socket has healed, the shell is removed by the oculist (the specialist that makes the false eye) and replaced with a specially molded false eye upon which will be carefully painted to look like the opposite eye.

After the surgery, a large pressure bandage is applied. This is usually kept on from one to two days. You may have some discomfort at this point, but medication is always prescribed by your doctor for this.
 
After the pressure dressing is removed, you may notice some swelling and/ or black and blue color on the eyelids. This is temporary and will heal by itself. When you open the lids, you will be able to see the plastic shell, or conformer in place. It may be clear or white.

A regular gauze patch is all that is necessary at this point. The plastic shell (conformer) is held in place by your eyelids and will not usually fall out by itself. A healing period of 4 to 6 weeks is necessary before the fitting of the final prosthesis.

An ocularist is a person who specializes in making a false eye also known as an eye prosthesis. 
     
Mr. Raymond Jahrling is one of the best ocularists in New England, and located very close to the hospital. His fittings usually involve three visits. During the first visit, Mr. Jahrling takes an impression and makes a mould of the eye socket. He  makes an exact impression and builds wax on it to exactly match the curve of the patient’s other eye. He then carefully paints the front part of the eye on a clear plastic disk under controlled lighting conditions.
 
Before the patient’s second visit, the plastic painted disk has been imbedded in the mold and the whole piece cured under controlled heat and pressure as might be pottery. When the patient returns, Mr. Jahrling paints in the blood vessel pattern on the white part of the eye and copies any other various tinges. On the third visit he fits the prosthesis, and instructs the patient on care and cleaning. The patient is then followed up in a month’s time for any minor adjustment.
 
When one loses an eye, there is obviously a need for extra protection to the remaining eye. Protective eyewear or safety glasses are strongly recommended for everyday use. Safety goggles are a must for all contact sports.

In conclusion, there are very few limitations after the loss of an eye. One may still engage in sports, drive a car, and lead a normal life.

The nurse from Retina Service will review your follow up appointment with your doctor at Mass. Eye and Ear, usually one week after surgery and your follow up appointment with Mr. Jahrling, the ocularist, usually four to six weeks after your surgery at Mass. Eye and Ear

In the interim, if the conformer should be dislocated, notify your doctor’s office. Do not put the conformer in any chemical cleaner or alcohol solution. Place in a clean bowl with tap water.
 
 For a guide to home care after enucleation, click here.