POST EVISCERATION
(Evisceration of the Globe)
 

Evisceration of the globe involves removing the entire contents of the eye including the cornea.  Placement of an intraocular implant for orbital volume enhancement would be the eye surgeon's option.  If an implant is inserted into the scleral husk it would be lesser in bulk than the contents removed, because of the purse string closure in the absence of the cornea.  (A consensus of ASO members expressed 'evisceration' cases as their second preference for fitting an ocular prosthesis.  The first choice being the 'scleral cover shell over a dysfunctional globe.  The reason being, the extraocular muscles (rectus and obliques) will remain attached to the sclera and will respond accordingly to movement of the sighted eye.  The prosthesis would be similar in thickness to that fitted over a shrunken globe.)  In rare cases where the cornea is retained, a large as possible spherical ocular implant would be required, this unfortunately results in the eviscerated globe's surface to be too smooth of a curvature to transfer all of its mobility to an overlying thin scleral prosthesis.

Contraindication to performing an evisceration still remains between ophthalmologists over the possibility of a hidden tumor developing within the sclera at a later date, or sympathetic ophthalmia that could effect the remaining eye.  (An oft cited statistic reports it could affect 1 in every 10,000 evisceration cases.)

The two simple evisceration cases presented here were diagnosed with blind and painful eyes where the entire orbital contents and the corneas were removed.  Instead of an intraocular implant being placed, a strip of gauze was packed into the scleral husk and removed several days post-operatively.  It left the scleral remnants gnarled, permitting the posterior surface of the prostheses to cling to the sclera husks like glove over fingers.  It is of interest so show the post-operative results after several years how one scleral husk (Fig. 14) remained unchanged, whereas, the other (Fig. 15) showed closure plus a loss of orbital fat (adipose) in the superior sulcus.

Figure 14A The evisceration (without implant) resulted in a well pronounced and firm scleral stump.  This allowed the impression fitted prosthesis to fit snuggly over the irregular contour.

Figure 14B Frontal gaze with the full thickness prosthesis restored facial symmetry.

Figures 14C, D, E The following three photos show the extent of motility in the horizontal plane and upward gaze.

Figure 14F As an added cosmetic measure when prescription eyeglasses are a necessity, it is advisable to have a similar power lens on the prosthetic side for balance.

Figure 15A Early post-operative results of the evisceration shows symmetry in the anatomical adnexa even with a temporary prosthesis over the eviscerated right eye.

Figure 15B This close up view taken one month post-operative shows a well pronounced scleral husk that easily accommodated a modified impression prosthesis that fit snugly into the scleral fissure.

Figure 15C The posterior view of the ocular prosthesis shows the peg-like extension that adapted to the scleral husk.  The motility of the prosthesis (not shown) was excellent.

Figure 15D Two and a half years later this unanticipated change in the structure of the eviscerated globe required a re-impression for the posterior surface of the prosthesis.

Figure 15E Post adjustment shows the superior sulcus to have a depression supra-nasally between the upper eyelid and the eyebrow that would not allow for any further correction (with the prosthesis).  However, cosmetic makeup did improve the appearance compared to how patient appeared 2½ years earlier.