The medical term for the removal of the eyeball refers to a spectrum of distinct surgical procedures defined by the amount of tissue removed from the eye socket, or orbit. These operations are only considered when the eye is damaged beyond repair, poses a threat to overall health, or causes pain that cannot be managed otherwise. The choice of procedure depends entirely on the underlying condition, such as a severe injury, untreatable infection, or the presence of an intraocular tumor.
Defining the Types of Eye Removal
The least invasive procedure is evisceration, which focuses solely on removing the internal contents of the eyeball, such as the iris, lens, and retina. This technique leaves the scleral shell—the white, outer layer of the eye—and the attached extraocular muscles completely intact. Preservation of these structures allows for a quicker recovery and often results in better movement of the prosthetic eye because the muscles remain undisturbed. Evisceration is generally the preferred choice when the underlying condition, such as a painful, blind eye, is not caused by cancer.
In contrast, enucleation is the surgical removal of the entire eyeball, or globe. The procedure involves cutting the eye muscles away from the globe and severing the optic nerve behind the eye. While the entire eye is removed, the surrounding orbital tissues and the eyelids are left in place. Surgeons often choose enucleation when the eye contains an intraocular malignancy, like melanoma or retinoblastoma, to ensure the entire tumor and a portion of the optic nerve are removed, reducing the risk of cancer spreading.
The most extensive procedure is exenteration, reserved for the most serious conditions, typically aggressive cancers. This operation removes the entire globe along with the surrounding soft tissues within the orbit. Depending on the extent of the disease, the procedure may also involve the partial or complete removal of the eyelid structures and parts of the bony orbit. Exenteration is performed when a malignancy has spread beyond the eye itself into the surrounding socket tissues, requiring wide tissue removal to eliminate the disease.
When Surgical Removal is Necessary
The decision to proceed with eye removal surgery is made only after all other treatment options have failed to preserve vision or life. One of the most common indications is a painful, blind eye resulting from conditions like end-stage neovascular glaucoma or phthisis bulbi, where the eye has shrunken and is causing chronic discomfort. Removing the eye in these cases offers the patient pain relief and an improved quality of life.
Intraocular malignancy is a major reason for performing enucleation, particularly choroidal melanoma in adults or retinoblastoma in children. These procedures are performed with the primary goal of eliminating life-threatening cancer and preventing its spread. Severe, irreparable trauma to the globe, such as a rupture, is another frequent indication, especially if the injury has led to an infection called endophthalmitis.
In cases of severe trauma, enucleation may be chosen to prevent sympathetic ophthalmia, a rare but devastating autoimmune response. This condition involves the immune system attacking the healthy, uninjured eye after injury to the other eye, potentially leading to blindness in both eyes. Removing the severely damaged eye eliminates the trigger for this autoimmune reaction, protecting the remaining vision. The surgical choice is a careful calculation of risk, disease eradication, and the potential for a good cosmetic outcome.
Post-Surgical Care and Prosthetics
Following eye removal, an orbital implant is surgically placed into the socket to restore volume and maintain the natural contours of the face. These spherical or ovoid implants are typically made from biocompatible materials like porous polyethylene, hydroxyapatite, or acrylic. Porous implants allow the body’s own blood vessels and tissue to grow into them, which helps stabilize the implant and reduce the risk of migration.
During the enucleation procedure, the eye muscles are carefully reattached to the surface of the orbital implant. This crucial step allows the implant, and subsequently the artificial eye placed over it, to achieve movement that mimics the healthy eye. The degree of movement transfer to the final prosthesis depends heavily on the success of the muscle attachment and the material used.
The creation and fitting of the artificial eye, known as an ocular prosthesis, is the responsibility of a specialist called an ocularist. The ocular prosthesis is not a full sphere but a thin, custom-made shell that fits over the orbital implant and under the eyelids. The ocularist meticulously matches the color of the iris, the shape, and the blood vessel patterns of the remaining eye to create a highly realistic appearance.
The prosthetic eye does not restore vision, as it is purely a cosmetic device that relies on the movement of the underlying implant and the surrounding eye socket tissues. The ocularist ensures the prosthetic is comfortable, easily maintained, and moves in concert with the natural eye. This provides the best possible cosmetic outcome and restores facial symmetry, helping patients manage the practical and emotional realities of eye loss.