What is evisceration?
Evisceration is an oculoplastic surgical procedure in which the orbital contents of the eye viz. the cornea, iris, lens, vitreous, and retina are surgically removed while keeping the external shell or the sclera intact. Apart from the orbital components, the muscles attached to the eye, the extraocular muscles, are left intact and no action is taken upon the optic nerve either. In order to maintain the appropriate orbital volume of the eyeball, a temporary conformer is placed. This can be replaced by an artificial orbital prosthesis once it has been made in a period of 6-8 weeks. Evisceration surgery is carried out by a specialist surgeon known as an oculoplastic surgeon.
Evisceration may be a necessary oculoplastic procedure for patients in the case of the following:
- Endophthalmitis – In the case of persistent endophthalmitis which remains non-responsive to antibiotics, the evisceration of ocular contents may be necessary.
- Penetrating trauma to the eye – In the case of traumatic injury to the face which has resulted in penetrative damage to the orbital structures, evisceration may be required to control pain.
- Blindness – Evisceration is recommended to reduce pain in patients with blindness.
How is evisceration surgery carried out?
The surgical procedure is usually carried out under general anesthesia or monitored controlled sedation by a licensed and qualified oculoplastic surgeon. Epinephrine may be also administered locally to reduce intraoperative bleeding and pain, post-operation. The patient undergoing the surgery is prepared and draped using sterile drapes. An eyelid speculum is placed to keep the eyelids open. A conjunctival peritomy is made at the limbus and subsequently, Wescott scissors are used to undermine the conjunctiva and Tenon’s capsule via anterior dissection. The intraocular contents such as the uveal tract, vitreous humor, the crystalline lens and the retina are then removed using instruments such as an evisceration spoon, spatula, or suction. Cautery is then utilized to achieve hemostasis. The sclera is left intact and the surgeon then evaluates and determines the ideal size of the implant to restore orbital volume. Implants may differ in material ranging from acrylic, polymethylmethacrylate (PMMA), silicone or hydroxyapatite. The eviscerated eye is also often bathed in antibiotics solution, especially in the case of endophthalmitis. Antibiotic treatment may last for up from 10 days to several weeks, keeping in mind the nature of the infection.
What are the advantages of evisceration compared to enucleation?
- As an oculoplastic procedure, evisceration surgery requires a shorter time than enucleation. This also reduces recovery time.
- Evisceration surgery is less complex when compared to enucleation, thereby reducing the risk of complications during surgery.
- The cost of evisceration surgery is lower compared to enucleation surgery.
- Evisceration surgery is less disruptive to the orbital tissues surrounding the surgical site when compared to enucleation surgery.
- In the case of infection following oculoplastic surgery, the risks of transmission to the nervous system are lower in the case of evisceration surgery when compared to enucleation surgery.
- In terms of pain and recovery caused by an oculoplastic surgery, evisceration is less painful compared to enucleation surgery and impacts the patient lesser.
What are the disadvantages of evisceration surgery?
Due to the exposure of the uveal contents during the surgery, there is a risk of an antigenic response in the other eye, thereby increasing the risk of sympathetic ophthalmia. Evisceration surgery may also increase the risk of the dissemination of ocular tumors to the surrounding orbital tissues.
Evisceration surgery is a complex oculoplastic surgical procedure which requires consummate skill and extensive experience. It involves the removal of the contents of the eyeball without damaging the external shell of the eye, or the sclera.
Due to the sensitivity of the eye, and to avoid damage to the surrounding orbital tissues as a result of surgery, evisceration surgery must only be performed by a highly specialized oculoplastic surgeon with extensive experience.
Dr. Debraj Shome is a highly experienced oculoplastic surgeon based in India. He has various accolades and medical distinctions to his name. He has received medical training in oculoplastic and cosmetic surgery in some of the best hospitals in the world.