Diagnosis and treatment

Welcome to this patient information video, produced by the Moorfields Eye Hospital Ocular Oncology service. It is designed for patients and carers to help them prepare for eye removal surgery, and to look after the socket, after removal.  

You may feel sore and bruised and should take regular painkillers as needed. You will probably feel most sore when moving your good eye.  Get plenty of rest and try to keep hydrated.  Whether at home or in hospital, the following shows you what to expect the next morning.

The next morning the dressing will need to be removed, and the eye bathed. In hospital, either the surgeon or nursing team will see you and answer any questions.  To clean the eye socket, you will need the following:

•            clean boiled water which has been allowed to cool,
•            clean cotton wool pads or balls, and
•            gloves if available.

You should then wash your hands thoroughly with soap and water and dry them well before removing the dressings. The dressing should be removed gently by peeling the tape from the forehead to the cheek, supporting the underlying skin. It can be normal for the pad to be blood stained, or have a sticky residue, which is the antibiotic ointment applied during surgery.  

The patient in this video had her surgery weeks ago, so the socket is not swollen and is well healed. Your eye socket and lid will be swollen and can look red and bruised. This can become worse over the first few days, before gradually getting better.  

We will now move on to show you how to clean the eyelids after eye removal surgery.

Once the boiled water has cooled, soak the cotton pad and squeeze out the excess. Gently wipe the lids from the nose side outwards. Discard the pad after one wipe, and try to avoid scrubbing the lids or the inside of the socket. This step can be repeated until the lids are clean. You can clean the socket as often as needed to keep it comfortable.

Once the socket is clean, you can begin to use your post-operative eye drops. You apply the drops as you would in any normal eye. This slide shows you how to access a full-length instructional video showing how to apply eye drops. It is common for the eyelid to be almost closed until you receive your artificial eye. The patient in this video had her surgery weeks ago, so the socket is well healed. At the time of your operation, the surgeon will have inserted a clear plastic shell, or conformer, in the socket.  You can see it in place in this patient.

This is the shell or conformer outside of the socket.  Very occasionally the shell may fall out after your operation.  If it does, wash it with soapy water, and rinse it thoroughly with cooled boiled water.

In this part of the video, we will demonstrate the technique to reinsert the shell.  

After washing your hands and the shell thoroughly, position the shell with the  more pointed end towards the nose. Stand at the side of the patient and gently lift the upper lid, whilst asking the patient to look up. Slide the shell in as high as it will go comfortably. Hold the shell in place and release the upper lid. Ask the patient to look down and gently pull down the lower lid, to allow the shell to sit back into the socket. Release and blink to check for comfort.  This technique can be used when inserting the shell yourself using a mirror to help you.  

If you are unable to get the shell back in without causing pain, stop, and try again the next day.  There is no danger if the shell is left out for a few days. If you are still having problems please contact your local Eye Hospital for assistance.

In the weeks following your surgery, you should use your drops as prescribed, and take things easy. You can gradually return to normal activity, including washing your hair and face as normal, provided you take care not to get soap into the socket.  If you experience increasing pain after the first few days, or are concerned in any way, please contact our clinical nurse specialists, or attend your local A&E in an emergency.  

The final part of the recovery from having eye removal surgery, is getting your artificial eye.  This will be similar to your eye, but not an exact match. This visit will also involve taking a mold of your socket, to allow your final eye to be made for you.

Here you can see an example of a shaped artificial eye in the central picture, next to a conformer on the right. This gives you an idea of what your artificial eye may look like, though it will be picked to match your original eye.

Here you can see our patient with her temporary artificial eye in place, which moves along with her good eye. Although the artificial eye does not move exactly as the original did, the range of movement is enough. Most patients find that people often have no idea they have an artificial eye, even when they come to eye clinic.

If you have any questions or concerns, you will have been given the clinical nurse specialist contact details when you were seen in the ocular oncology service.  

For issues relating to your artificial eye, please contact the ocular prosthetics department directly. In an emergency, specialist eye help can be accessed via Moorfields A&E.  

This video was produced by staff at Moorfields Eye Hospital, ocular oncology service.  

The team would like to thank everyone who contributed to the making of this video,  

and especially our patient without whom we could not have made this video at all.