Socket Reconstruction

Because of trauma or disease such as diabetes or a malignant tumor that leads to blindness and pain (phthisis), it is sometimes necessary to remove part (evisceration) or all (enucleation) of the eye. Most blind eyes do NOT need to be removed if they are not painful or if they have no malignant tumor. If a malignant tumor such as a retinoblastoma or melanoma is found in the eye, enucleation may be required. If an eye has become very painful with no useful vision from trauma or multiple intraocular surgeries, part of the eye may need to be removed by evisceration to stop the pain.

During an enucleation, the patient is typically placed under general anesthesia (completely asleep) and the entire eyeball (the globe) is removed. Usually, an implant is placed in the socket under the soft tissues and attached to the eye muscles to fill up the space left from the removed eye. With an evisceration, the white part of the eye (sclera) with its attached muscles is left alone. Only the inside degenerated part is removed. The implant is then placed inside the sclera and closed up under the soft tissue. The goal of surgery is to eliminate the tumor or pain and leave the patient with a good cosmetic outcome.

After eye removal surgery a temporary shell is placed over the soft tissue containing the orbital implant. This temporary shell maintains the shape of the eye socket. The temporary shell is left in place and requires no maintenance. After the socket has healed, which is typically one month after surgery, a prosthesis will be made by an ocularist. The prosthesis is molded to fit the unique shape of a patient's eye socket and is painted to match the fellow eye.

In most cases, the removal of a damaged and scarred eye will improve the cosmetic appearance but these judgments are always subjective (beauty is in the eye of the beholder). Because most patients having this surgery are already blind in the eye to be removed, their daily activities change little if at all.

Eye removal can be performed under sedation with local anesthesia (injections around the eye), but is usually done under general anesthesia.

You may simply decide to live with the pain and associated problems that a blind and painful eye can cause. However, if you have a tumor in the eye, you may require other procedures such as chemotherapy or radiation to deal with the malignancy.

Sometimes additional surgery is necessary to improve the volume and surface area of a socket. These procedures may include using a plug of fat from the patient's belly to restore lost volume and/or using a graft from the mouth to reconstruct the surface of a shrunken socket.

A prosthesis may not fit properly in the socket and may cause a patient discomfort and also may not look symmetric. This can be the result of a droopy upper eyelid or sagging lower lid. If this is the case the upper lid may be raised or the lower eyelid tightened to improve the appearance and fit of a prosthesis.