Enucleation

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.

Indications

Common indications for enucleation include ¹:

• trauma

• painful blind eye

• intraocular malignancy

• microphthalmia in a child

• phthisis bulbi

• 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

• edema

• 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.