Enucleation Surgery

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Enucleation (Removal of an Eye) Surgery

Removal of an eye is never an easy thing to deal with as a patient. Whether related to trauma or chronic eye disease, it can be emotionally and physically challenging. Dr. Dewan’s approach is to make this as easy and comfortable for patients as possible. His goal is help patients through this experience by providing experience and specialization that most doctors do not have. He also partners with excellent ocularists to provide you with the best cosmetic outcome following your surgery.
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I have had a chronic eye problem in my blind eye and am having pain. Will this help?

One of the most common reasons why Dr. Dewan removes an eye is this exact scenario. With some chronic eye illnesses, the eye eventually becomes blind. Over many months to years, a blind eye will then sometimes undergo a long process of scarring. Patients may notice the eye become cloudy, red, and sometimes even shrink and become misshapen. As this happens, for some patients the pressure in the eye will rise, which can then result in pain and discomfort. Patients may be treated with eyedrops to reduce the pressure or inflammation and this can provide some comfort. When the drops no longer work, surgery may be the best option. Removing the eye is the definitive way to get rid of chronic pain related to this scarring process.

Won’t having my eye removed hurt?

As with any surgery, patients may have some pain following enucleation surgery. Unlike the chronic, deep pain associated with the blind eye, surgical pain is short lived and is well treated with pain medications for 1-2 days following the surgery. Remarkably, while some patients may need stronger pain medicines, many patients use no pain medicines stronger than Tylenol or ibuprofen. Most importantly, the surgical pain goes away quickly, and patients no longer have the chronic pain they had prior to surgery.

How is the eye removed?

The surgery to remove an eye is performed in an operating room and takes approximately one hour. During the surgery, you are completely asleep. Dr. Dewan makes an incision in the clear “skin” that covers the eye, called the conjunctiva. From here, he isolates the muscles that move the eye and places sutures in them. The muscles are then removed from their attachments on the eye. The optic nerve at the back of the eye is then cut and the eye is removed from the eye socket. In place of your eye, Dr. Dewan places an implant into the eye socket. This implant will occupy the space your eye did previously. The muscles are attached to the implant and the conjunctival incision is closed with stitches. Antibiotic ointment is placed on the incision and a firm contact lens called a conformer is placed over the incision. Your eye is then patched and the surgery is complete.
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What is the conformer for?

The conformer is placed to occupy the space underneath your eyelids where you will eventually wear a prosthesis. This prosthesis is the “glass eye” that we think of. Without the conformer, it is possible that you might create scar tissue that could make creating a prosthesis more difficult. Patients generally do not feel the conformer and there is effectively no after-care associated with it.

What is the after-care for the surgery?

As mentioned above, patients may have some pain for a few days following surgery. Dr. Dewan will give you a prescription for pain medicine for you to take as necessary. There will be a patch placed over your eye that Dr. Dewan will remove at your post-operative visit 4-5 days following surgery. In the meantime, you are free to sponge wash your face and shower from the neck down. We ask that you do not lift more than 25 pounds for 1 week following the surgery. All other activities are ok, so long as you are comfortable doing them. Once the bandage is removed, you will use a small amount of ointment on the conformer 1-2 times daily. Dr. Dewan will see you again 4-6 weeks following surgery.

When do I get my prosthesis?

Dr. Dewan will provide some information regarding an appointment with an ocularist. An ocularist is the artist who makes the prosthetic eye. Your appointment with them will usually be 6-7 weeks following your surgery. The appointment takes several hours during which they will create a mold for your prosthesis and begin the construction of it. You usually get your prosthesis within 1-2 days of your ocularist visit.

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Will the prosthesis look different than my other eye?

Ocularists are very talented artists and do an excellent job matching the prosthesis to your other eye. Dr. Dewan also attaches the muscles to your implant, giving you some movement, particularly left and right movement for the prosthesis. While the movement is not perfect, between the excellent coloration and the presence of some movement, it is remarkable how realistic prosthetic eyes can look. In fact, it is likely that everyone has seen someone with a prosthetic eye and not noticed it.

How do I take care of my prosthesis?

The prosthesis is virtually maintenance-free! Most patients wear their prosthesis full-time and it typically doesn’t need to be removed with any regularity. Patients typically have the prosthesis cleaned and polished by the ocularist 1-2 times annually. Daily or regular cleaning by patients is not necessary. Patients may use artificial tears for comfort if necessary. Some patients get discharge around the prosthesis from time-to-time and if so, Dr. Dewan will prescribe a medicated eye drop to be used if this happens.

I’d like to discuss enucleation. What is the next step?

Dr. Dewan has extensive experience with enucleation and is happy to help you through this process. You should anticipate a consultation taking up to 1 hour as there is often many discussion points for patients. Dr. Dewan will thoroughly review your history and perform an exam and then discuss the entire process with you. Call us to schedule your consultation whenever you are ready.
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