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107 - Enucleation, evisceration and exenteration

Published online by Cambridge University Press:  12 January 2010

Enrique Garcia-Valenzuela
Affiliation:
Emory University, School of Medicine, Atlanta, GA
G. Baker Hubbard III
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Thomas M. Aaberg Sr.
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Ophthalmic surgeons may want to remove ocular structures when they are affected by neoplasia, when they are distressed by a severe infectious process, or when an end-stage ocular disease is causing pain. There are three types of ophthalmic intervention:

Enucleation

Removal of the entire eyeball, including sclera and cornea, leaving a stump of the optic nerve and the extraocular muscles. An intraorbital prosthesis is usually implanted.

Evisceration

Removal of all intraocular structures, leaving only sclera and sometimes cornea. An ocular prosthesis is usually implanted.

Exenteration

Removal of the eyeball and the orbital contents which may include removal of orbital bone.

Enucleation is the most frequently performed surgical approach for elimination of intraocular structures. When ocular disease has rendered an eye completely blind (incapable of perceiving the brightest light), any possibility of visual recovery is minimal. Frequently, such severity of pathology makes an eye painful and cosmetically unacceptable in spite of medical treatment. Although there are several procedural choices, the most widely accepted surgery is removal of the eye or enucleation because of its long-term outcome and safety. A frequent scenario where enucleation is recommended is after severe ocular trauma. A blind eye should be enucleated within 2 weeks after trauma to prevent sympathetic ophthalmia, a rare complication where the exposed uveal tissue leads to autoimmune attack of the contralateral healthy eye. Other indications for enucleation include infectious endophthalmitis, end-stage glaucoma, and malignant intraocular tumors.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 710 - 712
Publisher: Cambridge University Press
Print publication year: 2006

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References

Dortzbach, R. K. & Woog, J. J.Choice of procedure: enucleation, evisceration, or prosthetic fitting over globes. Ophthalmology 1985; 92: 1249.CrossRefGoogle ScholarPubMed
Nerad, J. A., Kersten, R., Neuhans, R.et al. Orbit, eyelids and lacrimal system. Am. Acad. Ophthalmol. BCSC, Section 7, 1996: 116–117.Google Scholar
Nunery, W. R. & Hetzler, K. Enucleation. In Hornblass, A., ed. Oculoplastic, Orbital, and Reconstructive Surgery, Vol 2. Baltimore, MD: Williams & Wilkins, 1990: 1200–1220.Google Scholar
Raflo, T. G. Enucleation and evisceration. In Tasman, W. & Jaeger, E. A., eds. Duane's Ophthalmology. Vol. 5, Chap. 82. Philadelphia, PA: Lippincott, Williams & Wilkins, 2000.Google Scholar

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