When an eye is removed due to injury, disease, or other medical reasons, the eye socket undergoes transformations. This procedure leads to immediate and long-term changes in the orbital anatomy. Understanding these changes is important for individuals undergoing eye removal and their subsequent care.
Surgical Approaches to Eye Removal
Eye removal involves different surgical procedures, each affecting the socket distinctly. The three primary methods are enucleation, evisceration, and exenteration. The choice of procedure depends on the underlying medical condition.
Enucleation involves complete removal of the eyeball, including its contents and a portion of the optic nerve. Surrounding structures, such as the eye muscles and eyelid lining, are preserved. An orbital implant is often placed to maintain volume. The eye muscles are reattached to this implant to allow for some movement of a future prosthetic eye.
Evisceration removes only the internal contents of the eye, leaving the scleral shell (the white outer layer) and attached eye muscles intact. A spherical implant is then placed within this preserved shell. This method may offer better movement for a prosthetic eye due to muscle preservation.
Exenteration is the most extensive form of eye removal, reserved for severe cases like aggressive cancers. It involves removing the entire eyeball along with surrounding structures, including muscles, fat, nerves, and sometimes parts of the eyelids and bony orbit. The extent of tissue removal depends on the disease’s spread.
Immediate Post-Operative Socket Changes
Immediately following eye removal surgery, the socket exhibits noticeable changes as it begins healing. Patients can expect swelling and bruising around the orbital area. This is a normal part of the body’s response to surgery.
A temporary conformer, a clear plastic shell, is often inserted behind the eyelids. It helps maintain socket shape, reduce scarring and contraction, and provide space for the eventual prosthetic eye. Eyelids may be temporarily stitched to keep the conformer in place.
Pain is common in the initial days, typically managed with prescribed pain relief medication. Watery or slightly bloody discharge may also be present from the healing socket. The initial healing period, where bandages are in place and swelling subsides, usually takes several weeks.
Long-Term Anatomical Transformations
Over time, the eye socket undergoes anatomical transformations following eye removal, particularly if an orbital implant is not used or is inadequately sized. The absence of the natural eye leads to volume loss within the orbit, resulting in a sunken appearance known as enophthalmos. This volume deficit can be significant, as the eye itself occupies about 7 milliliters of space.
Soft tissue contraction and fat atrophy contribute to volume loss. Orbital fat atrophy can occur, especially after secondary surgical procedures, chronic inflammation, or radiation. The remaining orbital fat may also shift, contributing to a hollow appearance in the upper eyelid region, known as a deep superior sulcus.
Bone remodeling can occur in the orbital bones over time. The extraocular muscles, which once moved the eye, may atrophy or shorten after enucleation, impacting ocular prosthesis movement. These long-term changes collectively affect the socket’s ability to retain a prosthesis and contribute to cosmetic challenges.
Living with an Ocular Prosthesis
An ocular prosthesis, or artificial eye, plays a significant role in managing the transformed eye socket. This device replicates the natural eye’s appearance and helps maintain the socket’s volume and structure. Fitting typically begins weeks or months after surgery, once the socket has healed.
Ocularists, specialists in creating and fitting artificial eyes, take impressions of the eye socket for a precise and comfortable fit. This custom fit is essential for optimal movement and symmetry with the remaining natural eye. The prosthesis sits over the orbital implant and beneath the eyelids, leveraging the implant for some movement.
The prosthesis helps to prevent socket contraction and supports the eyelids, contributing to a more natural facial appearance. Routine care involves cleaning the prosthesis and maintaining socket hygiene to prevent irritation and discharge. While an ocular prosthesis provides a good cosmetic outcome and can move somewhat, it does not restore vision, and its movement range is often less than that of a natural eye.
Addressing Potential Socket Issues
Despite the use of an ocular prosthesis, individuals with an anophthalmic socket may encounter several long-term issues. Socket contraction can occur, reducing the space available for the prosthesis and making retention difficult. This can result from insufficient tissue, scarring, or prolonged absence of a prosthesis.
Discharge and irritation are common concerns, often due to mucus accumulation or issues with the prosthesis surface. Regular cleaning and proper prosthesis fit can help manage this. Another potential issue is implant migration, where the orbital implant shifts within the socket, affecting the alignment and movement of the prosthesis.
Eyelid problems, such as ptosis (drooping of the upper eyelid) or malposition of the lower eyelid, can also develop. These issues may arise from a lack of support from the prosthesis, volume deficiency in the socket, or changes in surrounding tissues. Addressing these complications often involves adjustments to the prosthesis, medical management, or further surgical interventions to restore socket health and appearance.