Orbital Exenteration

Mainly performed for management of advanced adnexal malignancies, orbital exenteration is a radical surgery that involves complete removal of the eyeball, retrobulbar soft tissues, and most, or all, of the eyelids. The aim of exenteration is to achieve total local control of disease whilst, whenever possible, preserving normal tissues to optimise surgical rehabilitation. It requires careful pre-operative counselling and surgical planning in order to achieve an acceptable cosmetic outcome and minimise the psycho-social impact for the patient. Methods of orbital exenteration can be considered as: (1) Eyelid-sacrificing, where all orbital soft tissues and eyelids are removed, with or without the eyebrow, (2) Skin-muscle sparing, where some of the skin and muscle from one or both lids is preserved, with primary closure of the skin-muscle flaps over the cavity, and (3) Tarsal (eyelid sparing), where the tarsal plates and conjunctiva are spared. The choice of reconstruction depends on the exenteration type and extent, on the proposed adjuvant treatment, and on the ability for the patient to tolerate multiple reconstructive procedures. Skin-muscle sparing exenteration allows for rapid rehabilitation and maximises psychological adjustment, particularly in the terminally-ill patient with limited life-expectancy.