The term enucleation signifies the complete removal of the eye, which is detached from the extra-ocular muscles, which make it move, and the cutting of the optic nerve, which transmits visual impulses to the brain. This is the technique used in cases of ocular tumours which cannot be treated by any other therapy, or in the case of very serious traumas in which the eye has burst/exploded, thereby impeding the possibility for the surgeon in the emergency room/A and E (Accident and Emergency) to reconstruct the eye in its entirety and must therefore be removed.
The term evisceration means an operation in which, first the cornea, the transparent part of the eye, is removed and then the eye is emptied of its contents (iris, lens, retina etc.). In this case the extra-ocular muscles remain attached to the sclera (the white part of the eye), thus permitting free movement of the prosthesis. This type of operation is carried out in the case of blind or painful eyes, buphthalmos (enlarged eye due to an increase in internal pressure) or traumas where it is possible to save this part of the eye.
When demolitive surgery is carried out it is always necessary to think of the reconstruction. The better the reconstruction the better the final aesthetic outcome will be.
How to move the prosthesis.
In both cases today it is possible to reconstruct the socket in a manner that permits free movement of the prosthesis. There are nowadays excellent surgical techniques which permit optimal results.
What is an ocular implant and what is its function?
An ocular implant is a round marble made of bio-compatible material which serves to fill the socket and to consent free movement of the prosthesis. The ocular implant is attached to the muscles which have been detached, in the case of enucleation or inserted inside the sclera, which has been previously emptied, in the case of evisceration. With this surgical technique the presence of a mobile implant inside the eye socket permits the construction of a moulded customised prosthesis which will move in exactly the same way as the collateral eye.
Secondary reconstruction, what is it?
With certain patients, for whom this reconstruction technique has not been used at the time of the demolitive surgery, it is sometimes possible to carry out a so-called secondary operation of reconstruction. In this case it is possible to implant a marble or use a graft of autologous tissue (from one’s own body), consisting of derma and fat. This technique is used above all to fill the socket of patients who have not been implanted with a marble and who present a sunken socket.
After reconstruction with an autologous graft.