Removal of an eye is known as enucleation and is generally carried out when a patient has suffered a severe trauma, particularly where the eyeball or globe has been ruptured and it’s unlikely that sight will be recovered. There may also be concerns about a rare condition called sympathetic ophthalmia, where the good eye becomes inflamed after the affected eye is damaged.
In some cases, enucleation is recommended if a large eye cancer cannot be removed or destroyed, or where treating the cancer leaves the patient with little or no sight and a permanently painful eye.
Removing the contents of an eye only, which leaves the outer coating of the eye attached to eye socket muscles, is called evisceration.
Implants are used to replace either the entire eye or to fill an eviscerated eye.
Implants are usually made of a solid material, such as polymethylmethacrylate (PMMA), which is a type of acrylic plastic — Perspex is made from a type of PMMA.
When an implant is fitted into the socket, the eyeball muscles and soft tissues surround it. After healing, a prosthetic or artificial eye, which looks like a big contact lens, is placed over the implant. When the muscles move the implant, the artificial eye moves too. Nowadays, non-integrated implants are wrapped in a mesh, to which the muscles are attached, reducing the risks of drifting or rejection (known as extrusion or being pushed out of the socket).
Sometimes the implant can become exposed because of a breach of the lining of the sock (the conjunctiva) and if so, will require further surgery, ranging from a patch graft or even temporary removal. They can be used to replace other forms of implant, at enucleation or afterwards.
The tissues in the socket tend to shrink over time. This is rectified by using larger artificial eyes but these can give the wearer less eye movement and lead to drooping of the eyelids, or ptosis. As a result a few — less than ten percent — of patients ask for additional surgery to improve the look of their eye.
Your initial consultation is crucial to the success of any treatment.
It is your chance to explain and discuss your hopes and fears, so it may help if you write down a list of ideas and questions in advance. You may want to bring along a friend or family member for moral support or to ask additional questions.
It allows Mr Kamalarajah to review your medical history and lifestyle, photograph you (with your permission), assess your suitability for treatment and explain your options.
Finally, you can discuss possible procedures together so that you have a thorough understanding of what can be achieved and what risks there might be.
After the consultation, Mr Kamalarajah will write to your GP summarising the consultation.
An orbital implant is placed in the orbital cavity when the eye is removed and the tissues are closed over the implant. A temporary plastic disc (a clear conformer) is fitted on top of the implant for a month after surgery to prevent the socket shrinking.
Two months or more later, the patient sees an ocularist, also known as a prosthetist, who will create a detailed artificial eye or prosthesis that matches the natural eye.