ENUCLEATION It is the removal of the entire eye and part of the optic nerve - PowerPoint Presentation

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ENUCLEATION

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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

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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

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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

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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

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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

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

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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.

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Ocular prosthetics have limitations in their motility

Two designs of eye prostheses

Anophthalmic

ocular prostheses

Scleral

shells

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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)

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Light weight orbital prosthesis with or without specs

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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

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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

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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

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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

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Inspect socket daily for any infections or secretions

Any unusual discomfort, irritation or redness should be reported