Enucleation of the eye describes the surgical removal of the entire globe with the separation of all connections to the orbit, including optic nerve transection. Alternatives such as evisceration or exenteration can be considered according to the underlying diagnosis and disease.
Rarely, auto-enucleation can occur, which is associated with psychosis in the majority of those cases.
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Indications
Common indications for enucleation include 1:
painful blind eye
intraocular malignancy
microphthalmia in a child
as part of eye donation
Contraindications
Contraindications include the following ref:
intraocular malignancy with evidence of orbital spread
expected psychological trauma due to the loss of the eye
relatively in sympathizing eye
Procedure
After obtaining written informed consent the procedure is done under general anesthesia with the conjunction of local anesthesia around the eyeball.
Technique
eyelid retraction with the lid speculum or a traction suture
circumferential conjunctival peritomy and removal of Tenon fascia from the globe with blunt dissection between the rectus muscles
disinsertion of superior and inferior oblique muscles
optic nerve transection
minimize any orbital fat manipulation to reduce the risk of atrophy
Complications
Postoperative complications include the following ref:
hemorrhage
infection
post-enucleation socket syndrome or anophthalmic syndrome
Radiographic features
The imaging features described here are of normal postoperative appearance without developing complications or recurrent/residual disease processes.
CT/MRI
CT or MRI will show the absence of the eye globe, optic nerve and adjacent contents of the orbital cavity in the form of asymmetry on the affected side along with changes in the height and transverse diameter of the optic chiasm ref.
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