The Anophthalmic Socket

Question 1

Definitions of enucleation, evisceration, and exenteration?

Answer 1

Enucleation: removal of the entire globe while preserving other orbital tissues

Evisceration: removal of intraocular contents while preserving sclera, EOMs, optic nerve

Exenteration: removal of some or all of the orbital tissues including the globe

Question 2

Procedure of choice in blind eye when intraocular pathology is unknown or if ocular tumor is suspected without view of the posterior pole?

Answer 2

enucleation

Question 3

Ocular tumors most commonly requiring enucleation?

Answer 3

retinoblastoma and choroidal melanoma

Question 4

Proposed mechanism of sympathetic ophthalmia?

Answer 4

delayed hypersensitivity reaction to uveal antigens

Question 5

Initial treatment for non painful, blind, disfigured eye?

Answer 5

cosmetic scleral shell

Question 6

Absolute contraindication for evisceration?

Answer 6

presence or possibility of intraocular malignancy

Question 7

Advantages and disadvantages of evisceration compared to enucleation?

Answer 7

adv: better motility, simpler procedure, theoretically lower risk of spreading infection in endophthalmic eyes, less disruption of orbital anatomy, lower rate of implant migration and extrusion.
disadv: less patients are candidates, theoretical increased risk of sympathetic ophthalmia, yields less complete specimen for pathology

Question 8

How long after enucleation is pegging of bioactive implant material generally performed?

Answer 8

6-12 months

Question 9

Important barrier to extrusion of anophthalmic implant?

Answer 9

secure closure of Tenon capsule over anterior surface of implant

Question 10

How long after enucleation or evisceration is ocular prosthesis generally fitted?

Answer 10

4-8 weeks

Question 11

Treatment options for deep superior sulcus deformity following enucleation?

Answer 11

placement of subperiosteal secondary implant in orbital floor (pushes implant into superior sulcus), dermis-fat grafting, replacement with larger implant, modification of ocular prosthesis

Question 12

Diagnosis and treatment of retention of mucus and debris in superior conjunctival fornix after enucleation?

Answer 12

giant fornix syndrome; superior conjunctival resection

Question 13

Management of implant exposure or extrusion?

Answer 13

scleral patch graft, dermis-fat graft (over which conjunctiva can re-epithelialize)

Question 14

Rik factors for contracted sockets after enucleation?

Answer 14

Radiation, extrusion, multiple socket operations, poor surgical technique (excessive destruction of conj or Tenons, excessive post-op scar tissue formation), severe initial injury, removal of conformer or prosthesis for prolonged periods

Question 15

Indications for exenteration?

Answer 15

• Destructive tumors extending to orbit from adjacent structures
• Intraocular tumors (RB, melanoma) with extraocular extension
• Malignant epithelial tumors of lacrimal gland ( controversial)
• orbital zygomycosis refractory to more limited debridement
• sarcoma and other primary orbital malignancies that do not respond to chemo or radiation (such as rhabdo)

Question 16

Briefly describe the three types of extenteration

Answer 16

Subtotal: leaving part of periorbita and eyelid

Total: removal of all intraorbital soft tissues including periorbita, with or without eyelid skin removal

Extended: removal of all intraorbital contents as well as adjacent tissue (such as bony walls or sinuses)