Eyeball Destructive Surgeries
Indications
- Painful blind eye (e.g., end-stage glaucoma).
- Malignant tumors (e.g., retinoblastoma, choroidal melanoma).
- Severe ocular trauma with no visual potential.
- Severe infections like endophthalmitis or panophthalmitis.
- Cosmetic reasons in disfigured, blind eyes.
- Risk of sympathetic ophthalmia after penetrating injuries.
Types of Destructive Surgeries
1. Enucleation
Definition: Removal of the entire eyeball, sparing extraocular muscles and orbital contents.
Indications:
- Intraocular malignancies (e.g., retinoblastoma, melanoma).
- Painful blind eye.
- Prevention of sympathetic ophthalmia.
Complications: Orbital implant extrusion, infection, ptosis.
2. Evisceration
Definition: Removal of the contents of the globe while retaining the scleral shell and extraocular muscles.
Indications: Endophthalmitis, painful blind eye without malignancy.
Contraindication: Suspected intraocular malignancy.
Advantages: Better cosmetic result, preservation of orbital volume.
Complications: Infection, implant extrusion, rare sympathetic ophthalmia.
3. Exenteration
Definition: Removal of all orbital contents, sometimes including eyelids.
Indications: Orbital malignancies, life-threatening orbital infections, invasive fungal infections.
Types:
- Total Exenteration: Removes all orbital contents, including eyelids.
- Subtotal Exenteration: Spares the eyelids.
Complications: Disfigurement, delayed healing, intracranial extension risks.
Differences Between Enucleation, Evisceration, and Exenteration
| Feature | Enucleation | Evisceration | Exenteration |
|---|---|---|---|
| Structures Removed | Entire globe only | Intraocular contents, sclera intact | Entire orbital contents (+/- eyelids) |
| Indications | Tumors, trauma, pain prevention | Infections, painful blind eye | Orbital tumors, severe infections |
| Cosmetic Result | Moderate | Better (sclera preserved) | Poor (requires reconstruction) |
| Tumor Safety | Safe for intraocular tumors | Contraindicated in tumors | Safe for orbital tumors |
Postoperative Care
- Pain management and infection prevention.
- Ocular prosthesis fitting after healing (in enucleation and evisceration).
- Psychological support and counseling.
- Rehabilitation and cosmetic reconstruction (in exenteration cases).
Key Points for Exams
- Enucleation prevents sympathetic ophthalmia; evisceration does not.
- Evisceration is preferred when cosmetic outcomes are essential, and no tumor is present.
- Exenteration is disfiguring but lifesaving in specific malignancies or infections.
- Always rule out malignancy before performing evisceration.
- Orbital implants and prostheses are vital for cosmetic rehabilitation.