Enucleation
Encyclopedia
Enucleation is removal of the eye
, leaving the eye muscles and remaining orbital contents intact. This type of ocular surgery
is indicated for a number of different ocular tumors, in eyes that have suffered severe trauma, and in eyes that are blind and painful owing to other disease.
Auto-enucleation (oedipism) and other forms of serious self inflicted eye injury are an extremely rare form of severe self-harm
which usually results from serious mental illnesses such as schizophrenia. The name comes from Oedipus
, who gouged out his eyes in penance after having sex with his mother and killing his father. Some patients have apparently been inspired by the Gospel of Matthew
, which states: "...if the right eye offend thee, pluck it out and cast it from thee" (5:29).
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 and conjunctiva (the mucous membrane covering the natural sclera). Implants can be made of many materials with the most common being plastic, hydroxylapatite
, metal alloy or glass.
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. The prosthesis is fabricated by an ocularist
. 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.
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
, leaving the eye muscles and remaining orbital contents intact. This type of ocular surgery
Eye surgery
Eye surgery, also known as orogolomistician surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist.-Preparation and precautions:...
is indicated for a number of different ocular tumors, in eyes that have suffered severe trauma, and in eyes that are blind and painful owing to other disease.
Auto-enucleation (oedipism) and other forms of serious self inflicted eye injury are an extremely rare form of severe self-harm
Self-harm
Self-harm or deliberate self-harm includes self-injury and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions. These terms are used in the more recent literature in an attempt to reach a more neutral terminology...
which usually results from serious mental illnesses such as schizophrenia. The name comes from Oedipus
Oedipus
Oedipus was a mythical Greek king of Thebes. He fulfilled a prophecy that said he would kill his father and marry his mother, and thus brought disaster on his city and family...
, who gouged out his eyes in penance after having sex with his mother and killing his father. Some patients have apparently been inspired by the Gospel of Matthew
Gospel of Matthew
The Gospel According to Matthew is one of the four canonical gospels, one of the three synoptic gospels, and the first book of the New Testament. It tells of the life, ministry, death, and resurrection of Jesus of Nazareth...
, which states: "...if the right eye offend thee, pluck it out and cast it from thee" (5:29).
Classification
There are three types of eye removal- Evisceration - removal of the internal eye contents, but the scleraScleraThe sclera , also known as the white or white of the eye, is the opaque , fibrous, protective, outer layer of the eye containing collagen and elastic fiber. In the development of the embryo, the sclera is derived from the neural crest...
is left behind with the extraocular muscles still attached. - Enucleation - removal of the eyeballHuman eyeThe human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
, but the adjacent structures of the eye socket and eyelids remain. An intraocular tumor excision requires an enucleation, not an evisceration. - Exenteration - removal of the contents of the eye socket (orbit) 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 which is removal of the maxilla or the upper jaw bone/cheekbone
Reasons for eye removal
- CancerCancerCancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
of the eye (retinoblastomaRetinoblastomaRetinoblastoma is a rapidly developing cancer that develops in the cells of retina, the light-detecting tissue of the eye. In the developed world, Rb has one of the best cure rates of all childhood cancers , with more than nine out of every ten sufferers surviving into...
, melanomas, any other cancers of the eye or orbit) - Severe injury of the eye when the eye cannot be saved or attempts to save the eye have failed
- End stage glaucomaGlaucomaGlaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
- PainPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
ful, blind eye - In cases of sympathetic ophthalmiaSympathetic ophthalmiaSympathetic ophthalmia is a granulomatous uveitis of both eyes following trauma to one eye. It can leave the patient completely blind. Symptoms may develop from days to several years after a penetrating eye injury. See also the reviews by Damico et al. , Chu and Foster , and Friedlaender et al...
(inflammation of the eye) to prevent travel to other eye, in which, if untreated can cause blindnessBlindnessBlindness is the condition of lacking visual perception due to physiological or neurological factors.Various scales have been developed to describe the extent of vision loss and define blindness... - Congenital cystic eyeCongenital cystic eyeCongenital cystic eye 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 very small number of cases reported. An audit by Duke-Elder of the medical literature in English...
- In a deceased person, so the corneaCorneaThe cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Together with the lens, the cornea refracts light, with the cornea accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is...
can be used for a living person who needs a corneal transplant by a surgical operation called 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 and conjunctiva (the mucous membrane covering the natural sclera). Implants can be made of many materials with the most common being plastic, hydroxylapatite
Hydroxylapatite
Hydroxylapatite, also called hydroxyapatite , is a naturally occurring mineral form of calcium apatite with the formula Ca53, but is usually written Ca1062 to denote that the crystal unit cell comprises two entities. Hydroxylapatite is the hydroxyl endmember of the complex apatite group...
, metal alloy or glass.
Later, once the conjunctiva have healed and post-operative swelling has subsided, an ocular prosthesis
Ocular prosthesis
An ocular prosthesis or artificial eye replaces an absent natural eye following an enucleation, evisceration, or orbital exenteration. The prosthetic fits over an orbital implant and under the eyelids. Often referred to as a glass eye, the ocular prosthesis roughly takes the shape of a convex...
can be placed to provide the appearance of a natural eye. The prosthesis is fabricated by an ocularist
Ocularist
An ocularist is someone who specializes in the fabrication and fitting of ocular prostheses for people who have lost an eye or eyes due to trauma or illness...
. 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.