94 INTRODUCTION Removing an eye that is ill, damaged, or has little or no vision is a challenge to the ophthalmic surgeon. The psychological trauma and the physical disability are extreme and the patient needs compassion and support in order to return to a productive life. The preparation for surgery, postoperative appearance, and prosthesis fitting should be discussed prior to the procedure . The surgery must be performed in a way to provide the best conditions for a perfect prosthesis, which should look similar to the fellow eye, follow its movements, be comfortable and aesthetically pleas- ing. Nevertheless the desired results are obtained in only one-third to half of the cases, especially due to conjunctival retraction. 1 The loss of an eye causes severe changes to the anatomy and physiology of the orbit resulting in deformities that affect the relationship between the socket and the prosthesis. Surgical procedures should be performed meticulously to attain the best func- tional and cosmetic result and avoid complications and deformities. Evisceration consists in the complete removal of the ocular contents through a corneal or a scleral inci- sion, while preserving the conjunctiva, sclera, extra ocular muscles and orbital fat. The preservation of the cornea will depend on its clinical presentation and upon the surgeon’s evaluation. Enucleation is the removal of the entire eye follow- ing the desinsertion of the extra ocular muscles and the section of the optic nerve. If possible, an ocular implant should be placed during the procedure to restore the volume and preserve the movements. Evisceration achieves a better cosmetic result than enucleation because it is less traumatic to the orbital tissues and the extra ocular muscles. 2 The incidence of implant extrusion is also lower with evisceration. 3 There are reports of rare cases of sympathetic oph- thalmia following the procedure. It is a bilateral dif- fuse granulomatous uveitis characterized by keratic precipitates, ciliary injection, aqueous cells and flare, posterior synechiae, vitreitis, retinal vascular sheath- ing, and disc edema. Treatment includes aggressive anti-inflammatory therapy and immunosuppressors. Prognosis is reserved. INDICATIONS Evisceration is performed in every situation that requires the removal of the eye due to trauma, glaucoma, unaesthetic eyes for which the use of a prosthesis is not possible, and in some cases of Seminars in Ophthalmology, 25(3), 94–97, 2010 Copyright © 2010 Informa UK Ltd. ISSN: 0882-053 8 print/ 1744-5205 online DOI: 10.3109/08820538.2010.488575 Evisceration and Enucleation Ícaro Perez Soares, 1 and V alênio Perez França 2 1 Clínica de Olhos Hospital Mater Dei; Centro Oftalmológico de Minas Gerais; Policlínica oftalmológica - Oculi; Belo Horizonte, Minas Gerais, Brazil 2 Clínica de Olhos Hospital Mater Dei; Centro Oftalmológico de Minas Gerais; Policlínica oftalmológica - Oculi; Hospital São Geraldo, Federal University of Mi nas Gerais ABSTRACT Evisceration and enucleation are delicate procedures that result in psychological trauma and physical disability . The preparation is as important as the surgery itself to assure that the patient will return to a productive life. The procedure must be performed in a way to provide the best con- ditions for a perfect prosthesis, which should look similar to the fellow eye, follow its movements, be comfortable and aesthetically pleasing. Indications and contra-indications, surgical techniques, pre- and post-operative care and complications are discussed in this paper. KEYWORDS: eviscera tion; enucleati on Correspondence: Ícaro Perez França, Rua Timbiras 3468, Barro Preto. CEP 30140-062, Belo Horizonte (MG), Brazil. S e m i n O p h t h a l m o l D o w n l o a d e d f r o m i n f o r m a h e a l t h c a r e . c o m b y H I N A R I o n 0 7 / 2 0 / 1 3 F o r p e r s o n a l u s e o n l y .
