1. ENUCLEATION

2. It is the removal of the entire eye and part of the optic nerve
Indication –
Severe injury resulting in uveal tissue prolapse
Loss of perception
An irritated, blind, painful, deformed or disfigured eye usually caused by extreme glaucoma, retinal detachment
An eye without useful vision
Intra ocular tumors that is untreatable by other means

3. The procedure involves
Separation and cutting of each of the ocular muscles
Dissection of the tenon’s capsule (fibrous membrane covering the sclera)
Cutting of the optic nerve form the eyeball
Insertion of an orbital implant
A large pressure dressing is applied over the area

6. Evisceration
Surgical removal of the intraocular contents through an incision or opening in the cornea or sclera
Indications
Ocular trauma with ruptured globe
Severe ocular inflammation or infection

7. The optic nerve, sclera, extraocular muscles and sometimes the cornea are left intact
Advantage of evisceration over enucleation is that final cosmetic result and motility after fitting the ocular prosthesis are enhanced

9. Exenteration
Removal of the eyelids, the eye, and various amounts of orbital contents
Indications
Malignancies in the orbit that are life threatening
All other surgical management is not possible
Ex- squamous cell carcinoma of paranasal sinuses, skin and conjunctiva with deep orbital involvement

11. In most extensive cases it include removal of all orbital tissues and resection of the orbital bones.

12. Ocular prostheses
Orbital implants and conformers (ocular prostheses usually made of silicone rubber)
This maintains the shape of the eye after enucleation and evisceration to prevent a contracted, sunken appearance
This will protect suture line, maintain the fornics and promote integrity of the eyelids.

14. Ocular prosthetics have limitations in their motility
Two designs of eye prostheses
Anophthalmic ocular prostheses
Scleral shells

15. Eye prosthesis usually lasts about 6 years
When the socket is completely healed, the doctors refer them to ocularist (specially trained and skilled professional who makes eye prostheses)

17. Light weight orbital prosthesis with or without specs

18. Management
Removal of eye have physical, social and psychological problems for patients
The patients preparation should include information about the surgical procedure and placement of orbital implants and conformers
Availability of ocular prosthetics

19. Teaching about post surgical and prosthetic care
Inform them there will be large ocular pressure dressing – typically removed after a week
Ophthalmic topical antibiotic ointment applied in the socket three times daily
Take extra caution in their ambulation and movement to avoid injury
Inform that conformers may accidentally fall out of the socket. If this happens, the conformer must be washed, wiped dry, and place back in the socket

20. Self care teaching
Teach how to insert, remove and care the prosthetic eye
Proper hand hygiene must be obtain before inserting and removing ocular prosthesis
A suction cup can be used to remove the prosthesis
Avoid falling of prosthesis in the floor
When instructing – a return demonstration is important to assess the level of understanding

22. Hygiene and comfort is mandatory
Daily irrigation of the prosthesis with normal saline, contact lens solution or artificial tears
Removing crusting and mucous discharge that accumulate over night is performed with the prosthesis in place.
Malpostion can occur while wiping or rubbing
Use a clean finger to reposition it
Sometimes lubrications is used - irritation

23. Inspect socket daily for any infections or secretions
Any unusual discomfort, irritation or redness should be reported