Evisceration

Evisceration involves the removal of ocular contents (lens, uvea, vitreous, retina, and cornea) with preservation of the conjunctiva, sclera and extraocular muscles. For patients with a blind painful and or cosmetically disturbing eye, evisceration is favoured over enucleation provided that intraocular malignancy has been ruled out. Despite a very low risk of sympathetic ophthalmia, evisceration provides superior outcomes with less complications, cheaper cost and easier learning. Pre-operatively, the patient’s medical history (including general health and previous ocular surgery) should be reviewed, as well as any risk factors, such as scleral or conjunctival abnormalities. If adequate evaluation of the fundus is not possible, B-scan ultrasonography should be performed to rule out intraocular malignancy. Less invasive treatment options, including lubricants and cosmetic contact lenses or shells, should also be considered. Currently, a surgical technique with scleral modification (for example, a two-flap or four-flap technique with disinsertion of the optic nerve) is preferred, allowing placement of a larger implant, which improves cosmetic results by limiting enophthalmos and superior sulcus deformity. Implants of 18–22 mm diameter are commonly used, depending on the volume of the contralateral eye, orbital size, and the availability of adequate conjunctival lining. Although porous implants are still widely used, silicone spheres may be preferred due to low rate of exposure and extrusion and acceptable rate of implant migration. Silicone implant motility is similar to non-pegged porous implants. Pegging of the porous implants can improve motility, however it has a high complication rate and is rarely performed.