Eye removal surgeries

Question 1

Define evisceration.

Answer 1

Removal of the inner contents of the eye, leaving the outer scleral shell and sometimes the cornea.

Question 2

Define enucleation.

Answer 2

Removal of the entire eyeball including the contents of the eyeball such as the lens, iris, and vitreous humour.

The eye muscles and remaining orbital contents are left intact

Question 3

Define exenteration.

Answer 3

Removal of the entire contents of the eye socket.

This includes the globe itself, as well as the surrounding tissues, muscles and fat within the orbit.

Question 4

Give 4 indications for evisceration.

Answer 4

• Painful blind eye - ( often due to conditions like end stage glaucoma or trauma )
• Endophthalmitis
• Phthisis bulbi
• Expulsive choroidal hemorrhage
• Non malignant intraocular conditions

Question 5

Give 3 contraindications for evisceration.

Answer 5

• Known or suspected intraocular malignancy
• Extensive trauma involving the sclera
• Panophthalmitis with orbital involvement
• Patient preference

Question 6

Give 5 complications of evisceration.

Answer 6

• Retrobulbar hemorrhage
• Orbital oedema
• Dissemination of unexpected intraocular neoplasm
• Extrusion of implant
• Infection
• Wound dehiscence
• Orbital cellulitis

Question 7

Give 4 indications for enucleation.

Answer 7

• Intraocular malignancy or high suspicion for intraocular malignancy(most commonly uveal melanoma and retinoblastoma)
• Severe ocular trauma
• Painful blind eye
• Preventing sympathetic ophthalmia
• Microphthalmia
• Cosmetic deformity

Question 8

Give 2 contraindications for enucleation.

Answer 8

• Intraocular malignancy with evidence of spread
• Severe systemic illness
• Patient refusal

Question 9

Give 5 complications of enucleation.

Answer 9

Intraoperative
Removal of the wrong eye
Damage to or loss of extraocular muscles
Haemorrhage

Post-operative
Infection
Haemorrhage
Wound dehiscence
Extrusion of the conformer
Contraction of the fornices
Exposure of the implant
Ptosis
Enophthalmos
Orbital cellulitis
Pyschosocial problems

Question 12

Name the 3 types of orbital exenteration.

Answer 12

1. Subtotal:
   The eye and adjacent intra-orbit tissues are removed
   A technique for locally invasive tumors
2. Total
   All intraorbital soft tissues, including periorbita, are removed, with or without the skin of the eyelids.
3. Extended
   All intraorbital soft tissues are removed together with adjacent structures (usually bony walls and sinuses)

Question 13

Give 3 indications for exenteration.

Answer 13

• Orbital malignancies
• Painful or life threating orbital infections
• Chronic orbital pain
• Orbital deformities

Question 14

Give 3 contraindications for exenteration.

Answer 14

• Patients with bulky or massive orbital neoplasms
• Widespread metastatic disease
• Tumours with high likelihood of local regional recurrence
• Elderly patients with multiple medical comorbidities

Question 15

Give 5 complication of exenteration.

Answer 15

Early
Bleeding/Hemorrhage
Infection - Orbital cellulitis
CSF leak

Late
Facial disfigurement - Psychosocial impact
Phantom eye syndrome
Orbital cavity contracture
Recurrence of malignancy
Psychological effects - depression ,anxiety