Enucleation and Evisceration: What to Expect

Before surgery, your doctor will provide you with information and instructions about which medications you can and cannot take before your surgery. It is important that you tell the staff about any medications you take including supplements, and natural or alternative medications. It is especially important that you discuss any anticoagulation / antiplatelet (blood thinning) medication or medication for diabetes.

Be sure to arrange for a responsible adult to come with you, stay during surgery, and take you home. You cannot drive for 24 hours after surgery because of the anesthesia.

Enucleation is an outpatient procedure so you will be able to go home the same day. Bring all medication in original packaging. Jewelry (apart from a wedding ring) and cash should not be brought to the hospital.

This operation usually takes 1 to 2 hours and in most cases it is done under general anesthesia.

For enucleation surgery, the eye muscles and optic nerve are detached to allow the unhealthy eye to be removed from the socket. A variation of this surgery is evisceration where only the contents of the eye are removed, leaving the white part of the eye (the sclera) and the eye muscles intact. A small, round, ball implant replaces the tissue volume lost, and for enucleation where possible, the eye muscles are connected to the round implant. The implant is then covered in the patient’s own conjunctival tissue. A thin plastic shell called a conformer may be placed in the socket after surgery to help reduce swelling. Following surgery, the surface of your eye socket will look similar to the back of your lip.Some patients may also have the eyelids stitched together for a week or two to help reduce swelling. After a healing period of 6 to 8 weeks the artificial eye can be made and worn. The prosthesis or artificial eye can be removed and replaced easily. The implant is fixed in the socket and can only be removed surgically.

If there is severe infection at the time the unhealthy eye is removed a ball implant may not be recommended. If this does occur, an implant can usually be put in at a later date and this is called a secondary implant.Without an implant, an artificial eye will look sunken, with a deep hollow under the eyebrow. The artificial eye would be larger and heavier, which would put pressure on the lower eyelid, causing sagging of the eyelid.

After your operation you will have a pressure bandage and pad covering the socket. This is removed 6 to 14 days after surgery. Some patients may have some stitches to keep the eyelids closed, which are removed at your first post-operative appointment. Once the pressure bandage is removed, antibiotic drops or ointment is applied to the lids or socket. This is usually for one week and you may need someone to help you with these. It takes about 6 to 8 weeks for all the swelling to subside.

Most patients are only in the hospital for a few hours and go home the same day of surgery.

With all surgeries there can be some pain. It is important to tell nursing staff as soon as you experience pain so you can take appropriate medication to reduce it. Movement of the remaining eye will cause the implant to move and this can cause some discomfort due to the swelling from the surgery and movement against the conformer, if placed in the socket. Taking regular pain medication, resting, and minimizing eye movement for the first few days at home will also help to control pain after surgery. Also avoid watching TV or reading for the first few days after surgery.

Infection after enucleation and evisceration surgery is rare. Often antibiotic drops or ointment are prescribed for the socket after surgery, which help prevent infection.

There are few complications following enucleation or evisceration surgery. The most common complications relate to drooping of the upper eye lid or the appearance of a sunken eye which may require corrective surgery.

The conformer is not stitched in when placed in the socket after surgery and it may come out. There is no need for concern if this occurs. You can contact your doctor or hospital for advice on how to put the conformer back in, after you thoroughly clean it (soap and water).

It is important to rest after your surgery. This will assist with healing and pain management. You may require up to several weeks off work. If you feel you require longer, this can be discussed with your eye doctor or primary physician.

Having only one eye does not prevent you from driving provided the remaining eye has the level of vision required by your state. In the state of Michigan, the Department of State provides a form, Request for Driver Evaluation (OC-88), that can be completed and submitted to the Driver Assessment Section to request a review of an individual's driving skills. When it is safe to drive will depend on the level of sight in your remaining eye, depth perception, and the period of time you require adjusting to seeing with one eye. It can take 3 to 6 months to adjust to having vision in only one eye. This is often less if the vision had already deteriorated in the unhealthy eye that was removed.

You will have 3 appointments to fit your artificial eye (prosthesis). The first appointment will be about 4 to 6 weeks after your surgery. During this visit, the Ocularist will take an impression and mold of your eye socket. It is important to remain very still when the impression is being made as this will ensure the best fit of your artificial eye. Having the impression made is not painful but it is an unusual sensation of pressure and mild irritation. This only has to be tolerated for a few minutes. The Ocularist will then use this mold to create a prosthesis that matches the curves of your socket and begin painting it to match the color of your remaining eye.

When complete, the artificial eye is like a thick contact lens that sits over the covered implant from your surgery. You will receive the prosthesis on the second visit and will be given instructions on how to care for it. It is held in place by the way it is fitted to your socket and the muscles of your eyelids. About one month after you have been wearing your prosthesis, you will have a third appointment to see if any adjustments are needed.

In 2021, an artificial eye costs approximately $3,200. For insured patients, the first artificial eye made after the initial or subsequent surgery is typically covered. Replacing an old artificial eye is usually covered by most insurances as well (especially with children due to growth changes). However, a lost artificial eye is not covered.

As a general rule your artificial eye should be replaced every 8 to 10 years. Shorter replacement periods can be required if the artificial eye becomes uncomfortable to wear, there are complications with the health of the socket, or additional surgery is required. Annual check-ups with your Ocularist to have your socket inspected and have the artificial eye checked and polished will assist with the comfort of the artificial eye. They will also enable the Ocularist to advise when a replacement is required.

The artificial eye is made from an impression of your socket to maximize the fit. The artificial eye should not fall out or feel loose in the socket. You should contact your Ocularist if this occurs.

Removing and inserting the artificial eye is not difficult but it does require practice. Your Ocularist will be able to instruct you on how this is done.

The artificial eye is removed when required, usually for cleaning or to inspect the socket about once a month. If the socket feels slightly irritated, cleaning the artificial eye and socket with soap and water can help. Irritation of the socket can be caused by protein build up on the artificial eye from moisture. Some patients find using regular simple lubricating eye drops is helpful.

Tears are produced by the lacrimal gland. This gland is located under the skin just below the eyebrow and is not removed with this procedure. You will continue to produce tears and can cry with an artificial eye.

This may seem a silly question and most patients understand they cannot see with an artificial eye. The question more often comes from other people who may not understand the nature of the surgery to remove the eye and the nature of the artificial eye, which of course cannot see.

At first, the artificial eye can feel a little uncomfortable with a sensation that it is too big for the socket. For some people this sensation can take several days to subside. The socket may be watery when first wearing the artificial eye but should also settle after a few days.The artificial eye can at times feel dry. This can be due to environmental reasons, such as air conditioning, home heating or wind and can be relieved by using over-the-counter lubricating eye drops.

It can take up to three weeks before wearing your artificial eye feels completely comfortable and the watering and discharge begin to settle. Then you should have minimal to no noticeable sensation.

If your surgeon was able to connect the eye muscles to the ball implant you will have some movement of the artificial eye. At first this may feel unusual but not painful. After a few days you should not notice any sensation with this movement. The range of movement achieved varies for each patient but you will not have the full range of movement as the remaining eye. Your Ocularist will be able to advise you how to maximize the natural appearance of your artificial eye.

The main impact is reduced depth perception. This is especially apparent if vision loss in one eye has been sudden. At first simple tasks such as shaking hands, pouring drinks, tracking objects or navigating crowds will be challenging as the brain normally uses the vision from both eyes to assist with these tasks. Your brain will adapt over three to six months to only seeing with one eye and judging distances will improve.

The loss of vision in one eye will reduce peripheral vision on the affected side by about 20% to 30%. This is important to remember when crossing roads or driving as you will need to turn your head more to have a wider view of your environment.

Having an artificial eye should not prevent you from doing anything you would normally do with vision in both eyes. Your artificial eye is worn while you sleep shower, run, swim, play sport and work. Some daily activities like shaving or applying makeup and some work tasks may take a bit longer or may require a bit more concentration at first but will become easier as you adjust to having vision in one eye only. With any activity or task, it is very important that you protect the remaining sighted eye by wearing protective eye wear if there is any risk of injury to this eye or vision loss.

If the vision in one eye has been compromised for any reason; trauma or disease, you should wear safety glasses. It is very important that you protect the remaining sighted eye after enucleation surgery. Patients with one eye should always wear polycarbonate safety lenses (shatter resistant glasses). With activities and daily tasks, there is a higher risk of injury and vision loss. Your doctor will give you advice about suitable protective frames and lenses. Safety glasses means polycarbonate lenses in whatever frames you choose.

You should talk to someone about any emotional concerns you have or experience due to your vision loss or artificial eye. If you are concerned about mental health issues you experience, such as loss of self-esteem, fear and anxiety you should raise this with your primary physician.

Choosing to wear a patch instead of an artificial eye in most cases does not cause any problems, but you must continue to wear the conformer. The eye socket maintains its shape and size, and the socket can be fitted later with an artificial eye if you change your mind.  In some patients (not many) the eye socket will shrink and make fitting and wearing of an artificial eye difficult or even impossible in the future. Also, there tends to be more tears and mucus accumulating in the socket and discharging when an artificial eye is not worn.

Unless there are significant changes to your physical appearance there is no requirement to change a passport photograph. If traveling internationally while wearing an eye patch it is advised to have a letter from your doctor explaining why the patch has to be worn. If you have any concerns regarding your passport you can contact the U.S. Department of State.