The removal of an eye seems to be a drastic measure to most people. But people who require enucleation of an eye suffer from such things as a malignant tumor in or behind the eye, blind painful eye, or irreparable eye trauma. These conditions can be associated with chronic pain or may be life threatening, and enucleation can actually bring relief to patients who require it.

Eye injuries are the leading cause of vision loss in children. For adults in their later years, glaucoma, diabetes, and macular degeneration become the leading causes of blindness. These conditions can often come on quite suddenly, allowing little or no real time for adjustment. Sometimes they can come on gradually over a period of years causing progressive loss of vision, discomfort, or pain.

Many patients who require this surgery have no vision in the affected eye. Those persons who do have remaining vision realize that the removal of the affected eye will result in total loss of vision in that eye. All patients who undergo this procedure will require an artificial eye (ocular prosthesis) as a cosmetic substitute for their natural eye.

Today, there are very realistic looking and comfortable orbital implants and prosthetics available. At the time of enucleation, an orbital implant will be fit and covered with a clear conformer. Then, in about six to eight weeks after an enucleation, the patient is fit with a prosthetic or artificial eye by an ocularist. An ocularist is a technician specializing in custom prosthetic eyes that achieve the greatest degree of natural, cosmetic appearance.

The enucleation, or removal of the eye, is usually done under general anesthesia. If an existing medical condition prohibits general anesthesia, local anesthesia will be used. Immediately after the eyeball is removed, an orbital implant, called a Hydroxyapatite implant, is inserted into the socket. This implant is surgically covered with sclera, which is the white tissue on the surface of the eyeball. When you leave the hospital, the new implant will be covered with a clear conformer. A conformer is a piece of plastic or resin that covers the implant. The clear conformer will help protect the implant during the healing process. You will be able to see the implant through the clear conformer.

The most common type of orbital implant is the Hydroxyapatite Integrated implant, or HA implant. It is made of hydroxyapatite, which a substance derived from sea coral and is also widely used in orthopedic and dental implants. The HA implants are relatively new technology. Orbital implants are designed to move like the eye and keep the tissues of the orbit from sinking. The implant is surgically attached to the eye muscles, which allows for greater motility, or movement. The enhanced movement that HA implants are capable of (versus older technology) gives a greater sense of realism to the prosthesis.

The Hydroxyapatite implant is not the cosmetically appearing portion of the artificial eye. An oclularist will fit a prosthetic eye onto the implant. The prosthetic eye is the portion of the artificial eye that looks like the eye. Typically, 6-8 weeks after enucleation the permanent prosthetic is ready to be fit by the ocularist. The prosthetic is custom designed to match your natural eye color and patterns so it looks highly realistic. Today, prosthetic eyes are made of a poly-resin as opposed to glass.

For the time between the time of having the surgery and receiving a custom prosthetic eye, a temporary prosthetic eye, called an iris conformer, may be used. An iris conformer is similar to the clear conformer that you leave the hospital with, except that the iris conformer looks cosmetically like a natural eye. Many patients choose to get an iris conformer because it looks cosmetically better than the clear conformer. Since a custom prosthetic will eventually replace the iris conformer, it is used only for a short time. An iris conformer will closely match your natural eye color but will not be an exact match like the custom prosthetic will be. Insurance may cover the costs of a temporary iris conformer.

Some patients experience other conditions in association with implants, including ptosis or ectropion, that may require additional surgical procedures.

Some tearing of the eye is normal once the prosthesis is in place. Artificial eyes do require some maintenance such as periodic cleaning. For full after care procedures for enucleation, see the After Surgery Care section or click here.

For more information on enucleation and other eye removal procedures, and ocular prosthetics, visit the American Society of Ocularists at http://www.ocularist.org

To watch an instructional video on Hydroxyapatite implants, click here. (courtesy of Integrated Orbital Implants, Inc.)