Enucleation is the removal of the eye that leaves the

eye muscles The extraocular muscles (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 othe ...

and remaining orbital contents intact. This type of

ocular surgery Eye surgery, also known as ophthalmic or ocular surgery, is surgery performed on the eye or its adnexa, by an ophthalmologist or sometimes, an optometrist. Eye surgery is synonymous with ophthalmology. The eye is a very fragile organ, and requ ...

is indicated for a number of ocular tumors, in eyes that have sustained severe trauma, and in eyes that are otherwise blind and painful. Self-enucleation or auto-enucleation (oedipism) and other forms of serious self-inflicted eye injury are an extremely rare form of severe

self-harm Self-harm is intentional behavior that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin tissues usually without a suicidal intention. Other terms such as cutting, self-injury and self-mutilatio ...

that usually results from mental illnesses involving acute

psychosis Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...

. The name comes from

Oedipus Oedipus (, ; grc-gre, Οἰδίπους "swollen foot") was a mythical Greek king of Thebes. A tragic hero in Greek mythology, Oedipus accidentally fulfilled a prophecy that he would end up killing his father and marrying his mother, thereby ...

of Greek mythology, who gouged out his own eyes.

Classification

There are three types of eye removal: * Evisceration – removal of the

iris Iris most often refers to: *Iris (anatomy), part of the eye *Iris (mythology), a Greek goddess * ''Iris'' (plant), a genus of flowering plants * Iris (color), an ambiguous color term Iris or IRIS may also refer to: Arts and media Fictional ent ...

cornea The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical power ...

, and internal eye contents, but with the

sclera 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. In humans, and som ...

and attached extraocular muscles left behind * Enucleation of the eye - removal of the

eyeball Eyes are organs of the visual system. They provide living organisms with vision, the ability to receive and process visual detail, as well as enabling several photo response functions that are independent of vision. Eyes detect light and conve ...

, but with the eyelids and adjacent structures of the

eye socket 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 , of ...

remaining. An intraocular tumor excision requires an enucleation, not an evisceration. * Exenteration – removal of the contents of the eye socket, including the eyeball, fat, muscles, and other adjacent structures of the eye. The eyelids may also be removed in cases of cutaneous cancers and unrelenting infection. Exenteration is sometimes done together with maxillectomy (removal of the

maxilla The maxilla (plural: ''maxillae'' ) in vertebrates is the upper fixed (not fixed in Neopterygii) bone of the jaw formed from the fusion of two maxillary bones. In humans, the upper jaw includes the hard palate in the front of the mouth. The t ...

Indications

Cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

of the eye, such as

retinoblastoma Retinoblastoma (Rb) is a rare form of cancer that rapidly develops from the immature cells of a retina, the light-detecting tissue of the eye. It is the most common primary malignant intraocular cancer in children, and it is almost exclusively fo ...

and

uveal melanoma Uveal melanoma is a type of eye cancer in the uvea of the eye. It is traditionally classed as originating in the Iris (anatomy), iris, choroid, and ciliary body, but can also be divided into class I (low metastatic risk) and class II (high metasta ...

* Severe injury of the eye when the eye cannot be saved or attempts to save the eye have failed, such as after a globe rupture * End stage

glaucoma Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for fluid within the eye rem ...

Phthisis bulbi 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 e ...

* Painful, blind eye * In cases of

sympathetic ophthalmia 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 s ...

(inflammation of the eye) to prevent travel to the other eye, which if untreated can cause

blindness Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment� ...

Congenital cystic eye Congenital cystic eye (also known as ''CCE'' or ''cystic eyeball'') is an extremely rare ocular malformation where the eye fails to develop correctly ''in utero'' and is replaced by benign, fluid-filled tissue. Its incidence is unknown, due to the ...

* In a deceased person, so the cornea can be used for a living person who needs a

corneal transplant Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty ...

by a surgical operation called

keratoplasty Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty ...

* Constant infection in a blind or otherwise useless eye

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. 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. The eyeball is a slightly elongated sphere with a diameter of approximately 24 millimetres. 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 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 so ...

and

conjunctiva The conjunctiva is a thin mucous membrane that lines the inside of the eyelids and covers the sclera (the white of the eye). It is composed of non-keratinized, stratified squamous epithelium with goblet cells, stratified columnar epithelium ...

. Implants can be made of many materials with the most common being plastic,

hydroxylapatite Hydroxyapatite, also called hydroxylapatite (HA), is a naturally occurring mineral form of calcium apatite with the formula Ca5(PO4)3(OH), but it is usually written Ca10(PO4)6(OH)2 to denote that the crystal unit cell comprises two entities. ...

, metal alloy or glass. Later, once the conjunctiva have healed and post-operative swelling has subsided, an

ocular 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 ...

can be placed to provide the appearance of a natural eye. The prosthesis is fabricated by an

ocularist An ocularist specializes in the fabrication and fitting of ocular prosthetic, ocular prostheses for people who have lost an eye or human eye, eyes due to trauma or illness.{{Cite journal , last1=Khandekar , first1=Rajiv , last2=Changal , first2=Nusr ...

. 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. The external portion of the ocular prosthesis is painted and finished to mimic a natural eye color, shape and luster. It can be removed and cleaned periodically by the individual or a care giver. The two part system of orbital implant and ocular prosthesis provides a stable, and well tolerated aesthetic restoration of the eye socket. Although vision is not restored by removal of the eye with placement of an orbital implant and ocular prosthesis, a natural appearance can result. 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.

References

External links

Leading conditions of eye loss

Stories of eye loss
{{DEFAULTSORT:Enucleation Of The Eye Eye surgery

Classification

Indications

Orbital implants and ocular prostheses

See also

References

External links