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Enucleation

Enucleation means that the eye ball is removed surgically, leaving the surrounding muscles and tissues within the eye socket. This information is designed to help you understand the basics of the surgical process and artificial eye implant involved with enucleation, or removal of an eye. Our main focus is to inform patients about what happens after enucleation. This information is not intended to help patients make the decision to remove an eye or not. If you have any questions while reading this, please ask one of the nurses to assist you. 

At the time of surgery, the eye ball is removed and in most cases, replaced with a small ball made of glass, silicone rubber, or plastic. This replacement ball is not a natural part of the eye socket, and thus, is considered a “foreign body” in the eye socket. Though rare, it is possible that the implant could be forced out of the eye socket. To hold the implant in place and provide some movement to it, the muscles and other soft tissues are sewn in place around, or to, the small ball. In the great majority of patients, this implant is tolerated well without any problems. 

After the implant is placed inside the eye socket, a plastic or silicone shell (conformer) is placed over the front of the implant and between the eyelids. This helps maintain the eye socket shape and keeps the eye lids from shrinking. To ensure a successful surgery, great care should be taken not to disturb or irritate the skin or area around the eye socket.

After the surgery, a large pressure bandage is applied. This is usually kept on one to two days. You may have some discomfort at this point, and medication prescribed by your doctor can reduce this discomfort.
 
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 an ocularist -- a specialist who makes false eyes (ocular prostheses) -- can fit the final prosthesis.

Mr. Raymond Jahrling is one of the best ocularists in New England and is located very close to the hospital. His prosthesis fittings usually involve three visits. During the first visit, Mr. Jahrling takes an impression and makes a mold of the eye socket. He  makes an exact impression and builds wax on it to match the curve of the patient’s other eye exactly. Under controlled lighting conditions, he then carefully paints the front part of the eye on a clear plastic disk.
 
Before the patient’s second visit, Mr. Jahrling embeds the painted plastic disk in a mold. Then, the whole piece is cured under controlled heat and pressure, similar to making pottery in a kiln. When the patient returns, Mr. Jahrling paints the blood vessel pattern on the white part of the eye. On the third visit, he fits the prosthesis, and instructs the patient on care and cleaning. After a month, a follow-up visit is needed to make any minor adjustments.
 
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 daily 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 dislocates, 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.