This information is for patients who are to undergo an operation to remove the eye called enucleation.
Why do I need an enucleation?
This operation is sometimes necessary to treat eye cancer. It is only undertaken if all other treatment options are ineffective. Your doctor will have discussed the treatment options with you and explained that this is the best treatment for you. The aim of the operation is to remove your tumour.
What is enucleation?
An enucleation operation is where the eye ball is removed. The eyelids, eyelashes, eyebrows and surrounding skin will be left as they are. The eyeball is set inside the protective bony orbit. The eyelids protect the front of the eye and are lined with a protective membrane called the conjunctiva that also covers the front of the eyeball. The optic nerve is attached to the back of the eyeball. There are muscles attached to the surface of the eyeball which are responsible for moving the eye.
During the operation the optic nerve and eye muscles are cut and the eyeball is carefully removed. It is replaced with an orbital implant in the shape of a ball. Some of your eye muscles are then stitched to the orbital implant so the eye muscles will be able to move the implant. This means that when your artificial eye is fitted it will move in a similar way to your normal eye.
At the end of the operation your conjunctiva, the membrane lining the eyelids, is positioned so that it covers the implant giving the eye socket a pink appearance. After surgery, a temporary transparent plastic shell is put in place in the eye socket to allow healing and give shape. After a few weeks the clear shell will be replaced by an artificial eye (prosthesis). The prosthesis is shaped like a large contact lens and will sit in your eye socket over the orbital implant. You will be shown how to remove it so that you can clean it when required.
What are the complications of an enucleation operation?
The operation is usually straightforward but as with all surgery there is a small risk of complications. Short-term complications can include bleeding, swelling and infection. Long-term complications can include discharge and socket irritation or exposure of the ball implant.
What happens before the operation?
You will be given a general anaesthetic for this operation and you will be admitted to the hospital or the hostel one day before the operation so that you can have various blood tests and routine tests such as a chest x-ray and scans. You will be seen by one of the doctors and an anaesthetist, and you will be asked to sign a consent form for the operation. The eye that is to be removed will be carefully marked and checked again just before the operation.
What will happen after the operation?
You will go back to the ward after surgery and your eye will be covered with a firm dressing to help reduce swelling. This will stay in place for about one day.
Your eye may feel a little painful and sore, and you will be given pain killers if you need them. The day after the operation the dressing will be removed. Your eye socket will look red but it will become pinker in colour as it heals. Some bruising and swelling of the eyelids may occur; this can become worse over the first few days before gradually getting better.
You will be able to see the clear plastic shell that has been placed in your eye socket. This has a hole in the middle to help with airflow and drainage. It is easily removed but should stay in place until your socket heals and a temporary artificial eye is able to be fitted.
The nursing staff will show you how to clean your eye socket and give you some information on taking care of your eye and the shell. When you go home it is best to keep your eye uncovered to help healing but you can wear dark glasses until the swelling goes down. Very occasionally the shell may fall out. This rarely happens but if it does, follow the cleaning and care instructions the nursing staff give you after the operation. You will be asked to instil eye drops to prevent infection and take oral medications such as antibiotics and pain relievers.
How will I feel after the operation?
You may feel upset after having your eye removed, especially if you had some sight in your eye before the operation. Your emotions may fluctuate as you realise you are losing, or have lost, a part of you. You may also feel grief, sadness, bitterness and anger, and initially find it difficult to come to terms with having only one eye. Some patients have the sensation that the eye is still there or have temporary visual hallucinations or flashing lights. This is all quite normal and will improve over time.
If you are finding it difficult to come to terms with your diagnosis and the treatment you require you may like to talk to one of the Nurse Counsellors based at Moorfields. Counselling provides an opportunity to talk things through, allowing you the time to explore your thoughts and feelings and to make sense of the way you feel. Contact details for our nurse counsellors, as well as some other helpful organisations, are contained within the PDF leaflet which you can download on this page.
When do I get my artificial eye?
Once your socket has healed, your ophthalmologist will refer you to the ocular prosthetics department for measurement and fitting of a temporary artificial eye, taken from stock to replace the shell. This will be similar to your eye but not an exact match. Your final artificial eye will be made for you and custom painted to match your other eye. This will involve taking a mould of your eye socket so that it is the exact shape of your eye socket and fits over the orbital implant. This is a painless procedure that can take up to two hours, but ensures the eye’s shape, size and colour is made to match your own.
The process of making a prosthesis takes about a month and you will be fitted with a temporary prosthesis until your permanent one is ready. Once fitted your artificial eye will have should be an adequate range of eye movement. You will be able to sleep with it in place and once the socket is completely healed you can continue with your normal life. Eye make-up can be worn and you can swim or do other water sports (you are advised to wear goggles to avoid loss of the artificial eye). You are also advised to wear eye protection when doing any activity that could cause eye injury.
Can I drive after having my eye removed?
You can drive as long as the vision in your normal eye meets the legal requirements for driving and you have an adequate field of vision. You will need to remember that your overall vision will be reduced and you will have to turn your head more frequently while driving to compensate for the lack of vision on one side, however you will adapt. You will also need to take extra care when driving at night.
By law you are required to inform the Driver and Vehicle Licensing Authority (DVLA) of any change in your health and sight that is likely to affect your driving. You must also inform your insurance company. The DVLA drivers’ medical enquiries advice line – 0300 790 6806 – will be able to advise on what information to provide and help inform your insurance company about your eye removal.