What is enucleation?

Enucleation is the oculoplastic surgical procedure in which the entire globe of the eye is removed while keeping the adjoining periorbital and orbital structures intact. Enucleation surgery differs from evisceration in that in evisceration, the sclera is retained. Similarly, enucleation differs from exenteration, another surgical procedure where the globe of the eye along with the periorbital and orbital tissues are also removed. Enucleation surgery is a highly specialized oculoplastic procedure and is carried out by a surgeon known as an oculoplastic surgeon.

When is enucleation surgery indicated?

Enucleation surgery may be prescribed to patients by an oculoplastic specialist in the following situations:

  1. Malignancy – In the case of intraocular malignancy or orbital tumors, specifically in the case of uveal melanoma and retinoblastoma, enucleation surgery may be necessary for the patient.
  2. Trauma – Penetrative trauma of the eye may result in extensive, irreversible orbital damage. In such cases, an oculoplastic procedure such enucleation surgery may be necessary.
  3. Blindness – In the case of persistent and chronic pain in the blind eye, enucleation surgery may be carried out.
  4. Sympathetic ophthalmia – In patients with significant risk of sympathetic ophthalmia in response to orbital trauma, enucleation surgery may be considered.
  5. Microphthalmos – In the case of microphthalmia where congenital malformations in the size or anatomy of the eye may be present in the patient, oculoplastic surgeons may recommend enucleation surgery.

How is enucleation surgery carried out?

Oculoplastic surgeons perform enucleation surgery as an out-patient procedure with the patient under general anesthesia. Local injection of epinephrine is also carried out in order to aid hemostasis and aid in the postoperative management of pain. A limbal conjunctival peritomy is then carried out using Wescott scissors followed by the blunt dissection in the Tenon’s plane in each of the oblique quadrants. The rectus muscle is then isolated with a muscle hook and secured and then cut at the insertion to the globe of the eye.  After the free rotation of the globe has been secured, the optic nerve is located, and cut. Hemostasis is achieved using cautery and application of pressure.

What are the advantages of enucleation surgery?

Enucleation surgery may be advantageous in that it allows for the histological examination of the orbital contents such as ocular globe and the optic nerve. This is extremely relevant in the case of certain tumors where histology may allow the extent of malignancy. In terms of the aesthetics of the enucleated socket in comparison to eviscerated socket, no significant difference was reported by both patients and observers in retrospective studies.

What are the disadvantages of enucleation surgery?

Enucleation surgery may lead to the reduction of implant motility. Studies have shown that patients with enucleation reported statistically lower implant motility when compared to evisceration patients. Additionally, enucleation may increase the risk of other ocular complications such as enophthalmos and deep superior sulcus.

What are the possible complications of enucleation?

Enucleation is a significant oculoplastic procedure and may have the following risks associated with it:

  1. Potential damage to extraocular tissues and surrounding orbital tissues
  2. Hemorrhage
  3. Postoperative infection or wound dehiscence
  4. Exposure, extrusion or migration of the ocular implant placed after enucleation
  5. Ptosis, commonly known as drooping of the eyelid
  6. Contracture of the eye socket
  7. Ectropion or entropion
  8. Deep superior sulcus

Enucleation surgery is a complex oculoplastic procedure which must be undertaken after extensive consultation with a highly experienced oculoplastic surgeon after evaluation the physical, physiological and psychological consequences of the removal of the eye.  The surgery must be performed by a highly specialized and skilled oculoplastic surgeon who has extensive experience with orbital and lacrimal surgery.

Dr. Debraj Shome is an internationally reputed oculoplastic surgeon who has several prestigious grants and awards to his name. He has been trained in oculoplastic surgery at the LV Prasad Eye Institute in Hyderabad, India and has been voted among the top surgeons in India by multiple agencies.