Enucleation of the eyeball

Such surgical treatment as enucleation of the eyeball is performed quite rarely, in exceptional cases, when only the removal of this organ gives the patient a chance to stay alive and lead a relatively normal life.

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Indications for the procedure

The attending physician or a council of physicians can make a decision to prescribe such an operation only in exceptional cases. The indications for surgical intervention are as follows:

• Retinoblastoma or other malignancy affecting the eye area.
• A consequence of severe trauma to the face, including the eye and, accordingly, the eyeball.
• Atrophy of eye tissue and nerve endings.
• A prolonged inflammatory process occurring against the background of complete blindness of the patient.
• Other pathological processes with completely impaired visual function.
• Severe form of glaucoma.
• Threat of progression of sympathetic ophthalmia.
• Severe penetrating wound or contusion.
• Cosmetic nature of the operation with subsequent plastic surgery (installation of an implant - prosthesis).
• Severe pain symptoms in the eye with complete blindness.

Technique of operation

Today, this surgical treatment is performed in almost all ophthalmological departments and centers. But in order to protect yourself from unpleasant consequences, the patient should choose an institution for treatment with the appropriate modern clinical equipment, high professionalism and experience of doctors in performing such operations.

Today, you can get acquainted with the ratings of hospitals and reviews about them both on the Internet and by talking to patients of the clinic chosen for treatment.

Once a doctor or a council of doctors has decided that enucleation of the eye is inevitable, the patient is prepared for the operation. For small patients, this procedure is performed under general anesthesia, while adults receive a local anesthetic.

Local anesthesia is usually done retrobulbarly (the drug is injected directly into the eyeball with a needle and syringe - 2 ml of a 2% solution of novocaine) or eye drops can be used (1% solution of dicaine). After this, the patient is placed on the operating table.

The further technique of the operation is as follows:

• Using a retractor, the organ to be removed is opened.
• Very carefully, an experienced surgeon separates the eyeball from its bed. The excision is carried out along the perimeter.
• Then a special surgical hook is inserted into the eye socket.
• While supporting the organ, the rectus muscles are cut off, the oblique muscles remain intact.
• The cut muscle fibers are brought out.
• Special medical scissors are inserted into the surgical wound and brought to the optic nerve, after which both it and the oblique muscle fibers are cut off.
• The eyeball is removed from the eye socket.
• Bleeding is stopped using a solution of hydrogen peroxide and pressure tamponade.
• Three to four catgut sutures are applied to the conjunctival wound.
• A 30% solution of sulfacyl is instilled into the wound.
• A pressure bandage is applied to the surgical site.

To create the illusion of a mobile eye, a piece of fat excised from the buttocks is implanted into the eye opening. In another case, the patient undergoes plastic surgery, which involves the introduction of a carefully selected eye prosthesis. It is attached using modern material to the muscle tendons remaining in the eye socket.

Thanks to innovative techniques and modern materials, it is quite difficult to distinguish an artificial eye from a real one. This allows a person to lead a normal social life.

Enucleation of the eyeball after brachytherapy

Brachytherapy is a type of contact radiation radiotherapy. The essence of the method is the introduction of a radiation source into the affected organ, which affects damaged cells. The advantage of this procedure is the ability to directly deliver the highest possible dose of radiation to the affected area. At the same time, the remaining tissues of the body are subjected to minimal "bombardment" of radiation.

Surgical treatment for complete removal of the eyeball is performed quite rarely, in 6-11% of patients with the above indications. And only in one case is enucleation of the eyeball performed after brachytherapy. This is a good indicator, since it indicates that in other cases the eye, as an organ, was preserved.

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Complications after enucleation of the eyeball

The operation is performed, after which the patient faces a period of postoperative recovery and psychological rehabilitation, which may be marred by postoperative complications.

Like any operation, the procedure in question is quite traumatic. Therefore, complications after enucleation of the eyeball are possible as follows:

• Development of an inflammatory process in the injured eye socket.
• Bleeding.
• Swelling of damaged tissues.
• If the sanitation requirements were violated, the eye may become infected, which “pulls” even more dangerous consequences.
• If a prosthesis is installed, in isolated cases it may shift relative to the place of attachment. In this case, repeated surgical intervention is required to eliminate the defect.
• An allergic reaction to the use of certain medications.

Postoperative period To prevent the development of the inflammatory process and to quickly remove tissue swelling at the site of the operation, the patient is prescribed broad-spectrum antibiotics in the postoperative period. These can be intramuscular injections, ointments and drops for local use. For example, such as ciprolet, vigamox, dilaterol, ciloxan, levomycetin, tobrex, tsifran, ciprofloxacin, floxal, signicef.

Vigamox eye drops are dripped into the affected eye area for at least four days. The schedule and dosage are simple: one drop three times a day. In this case, all sterility rules must be observed so that the source of infection does not get into the wound. To do this, after the cap is removed from the package, do not touch non-sterile objects with the pipette. Hands performing the instillation must also be sanitized.

A contraindication to the use of this drug may be high individual sensitivity to the main or auxiliary components of the drug.

If there is a threat of viral invasion, the patient receives antiseptic medications: okomistin, vitabact, miramistin.

For some time, the operated patient also receives painkillers, which help reduce the pain in the affected eye. In most cases, the ophthalmologist prescribes one of these drugs to his patient: benoxy, inocaine, alcaine.

Inocaine eye drops are dripped one drop at a time directly into the affected area. The anesthetic effect of the drug can be extended if dripped three times with an interval of four to five minutes.

A contraindication to the use of this drug inocaine may be hypersensitivity to the components of the drug.

During the period of complete wound healing, the requirements for the sterility of materials in contact with the surgical site must be increased.

At this stage, the psychological side is also important. The patient may painfully experience the loss of an eye and may need the help of a professional psychologist, but nothing can replace the psychological and physical support of loved ones.

As has already been said in this article, surgical intervention, which in medicine has the term - enucleation of the eyeball - is prescribed quite rarely. But if the question of its implementation has arisen, you should protect yourself from unpleasant consequences. To do this, the patient should choose an appropriate institution for treatment. It should have a good reputation, should be equipped with appropriate modern clinical equipment. Not the least role, and perhaps even the leading one, is played by the experience and qualifications of doctors in carrying out this type of surgical treatment. To solve this issue, you can use the Internet or talk to patients of the clinic chosen for treatment. In psychological terms, such a patient, more than ever, needs the support of family and friends during this period.

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