POST ENUCLEATION
(Enucleation of the Eye and the Embedded (Motility) Implant)
 

When an eye is surgically removed from the orbit it involves freeing up the conjunctiva (membrane tissue over the sclera that contains the blood vessels).  This is a 360 degree incision at the corneal scleral juncture.  A muscle hook is then placed between the conjunctiva and the sclera to identify and tag the four rectus eye muscles (for later attachment to a motility implant).  The oblique muscles may also be tagged, but most eye surgeons will simply detach them before severing the optic nerve and removing the eyeball.

An orbital implant (preferably 'motility' type) of appropriate size would be selected and embedded within the muscle cone where the eye had been.  This orbital implant would have the dual purpose of first restoring most of the orbital volume lost after the eye was removed thereby preventing an enophthalmic (sunken in) appearance.  Secondly, the tagged rectus eye muscles would be sutured to the implant's surface in similar locations to where they were attached to the eyeball.  (This attachment will later convey motility to the flush fitting ocular prosthesis.)  Purse string closure of the underlying Tenon's capsule and conjunctival tissue completes the procedure.  A clear or opaque plastic or silicone conformer would then be inserted under the eyelids to retain the fornices during the post-operative healing process (usually 4 to 6 weeks), after which the ocularist will begin the process of fabricating and fitting the first prosthesis.

Due to the various types of motility implants presently in use this subject will not be discussed, unless it involves one of the (future) case presentations.  At present, we would like to explain some of the problem fitting conditions relating to the eyelids and orbit that are immediate (post-op) and later anatomical orbit changes.

The following enucleation case presentations exhibit a number of complicated fitting conditions that are not always addressed by ancillary providers or inexperienced prosthetic eye fitters.  Which is good reason to refer to our Useful Links page to find a member or members of the American Society of Ocularists within your area that are capable of handling the following described problems.

Post Enucleation (Photos & Descriptions)

• Orbital Fat (Adipose Tissue) and the Advantage of Youth
• Loss of Orbital Fat (Adipose Tissue) in the Geriatric Patient
• Recurrent Orbital and Eyelid Changes
• Continuous Adipose Tissue Loss (A Geriatric Problem)
• Paralysis of the Upper Eyelid Required Surgical Correction
• Prolapsed Orbicularis Muscle (Lower Eyelid Flaccidity)
• Post Operative Severe Edema (Rx: Pressure Stem Conformer)
• Long Term Prosthetic Absence Results in Prolapsed Lower Lid and Loss of Fornix