Perhaps the most difficult decision an ophthalmologist faces is the decision to recommend enucleation—the removal of an eye. This operation is generally recommended in dire circumstances—such as in advanced cases of retinoblastoma, for example—and when there are no other options, or if an eye is blind and painful. A patient who has lost an eye may face a difficult period of readjustment, and may experience difficulty with such everyday activities as driving, reading, and participating in many sports, although most people are eventually able to adapt in many ways.
There are three kinds of eye removal surgery: Evisceration, enucleation, and exenteration.
- Evisceration involves removal of the contents of the eye—the iris, the cornea, and the vitreous humor. The surgeon leaves behind the sclera and the extraocular muscles that surround the eye.
- Enucleation is the removal of the entire eyeball, leaving behind the eyelids, muscles, and other structures.
- Exenteration is the removal of all the contents of the eye socket, including the above-listed parts of the eye and often the eyelids as well.
What Are the Reasons for Removing an Eye?
In some cases enucleation may be the only solution to chronic, idiopathic eye pain (i.e., pain that has no discernible cause). Other reasons for removal of an eye include:
- Malignancy (cancer)
- Glaucoma that has reached its final stages
- Trauma that has severely damaged the eye
- Sympathetic ophthalmia—an autoimmune condition in which the body’s immune system responds to an injury to one eye by attacking the other eye as though it were foreign tissue
- Cystic eyeball—a congenital condition in which the eye does not develop properly in utero, and non-functional, fluid-filled tissue forms in its place
- Recurrent infection in an eye that is already blind
What to Expect from an Eye Enucleation Procedure
If you and your doctor have decided that you need to have an eye removed, you will be advised not to take aspirin for any reason for two weeks prior to the procedure, and not to take any NSAIDs (non-steroidal anti-inflammatory drugs such as Advil or Motrin) for five days. On the day of the procedure the surgeon and nursing staff will double-check with you and your doctor to confirm which eye is to be removed. After you are placed under general anesthesia, your eyelid will be retracted with a lid speculum, and the lid may be held open with a suture for the duration of the procedure. You surgeon will take great care not to unnecessarily disturb the orbital fat (the fat tissue that helps to hold your eyeball in place) in order to prevent this tissue from atrophying over time, which could cause the eye socket to acquire a hollowed-out appearance. After the eyeball has been removed, an implant will be inserted into the socket in order to prevent infections and preserve your physical appearance as much as possible. The size of the implant will be determined by your doctor after careful consideration—with a smaller implant there is less chance of extrusion (i.e., the implant popping out), whereas a larger implant will look more natural and may be able to move more like a natural eye. Most eye implants are made of glass, plastic, or a mineral known as hydroxylapatite.
How Do I Adjust to Losing My Eye?
Following the removal of your eye, you may face a difficult adjustment period. The loss of depth perception and a significant portion of your field of vision (including peripheral vision on one side), may affect your ability to drive a car, and your driver’s license may be subject to some restrictions, depending on the state where you live. For example, the state of New York requires anyone who has lost the use of a hand, a leg, or an eye to meet with a DMV examiner, who will determine what restrictions—if any—need to be placed on their license. However, having an eye removed does not necessarily mean that you will lose your ability to drive. Many people who undergo eye enucleation surgery experience anxiety about their physical appearance, and depression is not uncommon. Support groups exist to help you through this ordeal, however, and you should not hesitate to see a therapist if you need help adjusting psychologically to the loss of an eye. It is not rare for patients who have undergone eye removal surgery to experience hallucinations, phantom pains, and headaches, and for a small percentage of patients these can be severe enough to be debilitating.
Roughly 25 percent of patients experience phantom pain in the removed eye, meaning that they have the sensation that the eye is still there, and it hurts. Many other patients experience painless but disturbing phantom sensations. About 30 percent of patients will experience visual hallucinations in the removed eye. These hallucinations are usually just abstract shapes and colors, although about 10 percent of patients will experience detailed hallucinations, which are often faces, or even—strangely—cartoon images. This condition is known as Charles Bonnet Syndrome.
What Are The Risks of Removing My Eye?
As with any surgery, eye enucleation carries certain risks, and your doctor should discuss these risks with you. The possible complications that can occur during or following the removal of an eye include:
- Loss of function in the extraocular muscles, leading to decreased motility of the implant
- Infection
- Implant extrusion—the implant may pop out if it does not fit properly
- Ptosis
- Visual hallucinations
- Imperfect cosmetic appearance