A detailed anatomic knowledge of the bony orbit, eye, and contents within the orbit, is crucial to orbital surgery. In fact, in the early period of Dr. Isaacs’ fellowship training, one of his mentors advised him that an orbital surgeon should know the anatomy so well that he/she should be able to operate in the dark or with the eyes closed. Well, this actually occurred to Dr. Isaacs! He was operating in a child’s orbit with a malignant tumor when the entire power went out at a major academic institution! Rest assured, the child did extremely well without any complications.
There are a variety of indications for removing the eyeball. For example, a blind and painful eye despite medical treatment is an indication for eye removal. Another indication would be a cancer inside the eye, such as a malignant melanoma. Whatever the cause, Dr. Isaacs consider each case carefully and considers all options with the patient.
Undergoing this procedure can be emotionally difficult, not only because of the reason the eye is being removed, but also because of the loss of the eye itself. We therefore will try and do our part as best as possible, and provide you with the steps to expect during your consultation.
The two procedures that accomplish this are evisceration and enucleation. These are two fundamentally similar procedures with different indications and possible outcomes.
This is a tissue-sparing procedure that involves removal of the cornea and the intraocular contents. There is minimal dissection of the conjunctiva, and surgical manipulation of the eye muscles is avoided. The sclera remains, and the eye muscles remain attached to it. Scleral flaps are then formed and an implant is then typically placed. There are various types of implants, and Dr. Isaacs can discuss those options with you at your consultation.
This is a procedure that removes the eyeball in its entirety. The bulbar conjunctiva is dissected off the eye and the eye muscles are carefully disinserted from the eye. The optic nerve is then severed and the eye is removed. An implant is then typically placed. There are various types of implants, and Dr. Isaacs can discuss those options with you at your consultation.
Surgery is done on an outpatient basis, typically under general anesthesia. You can expect to go home with a patch over the surgical side, and it will be removed at your 1 week postoperative visit. Once your healing is complete, you can see an ocularist to make an ocular prosthesis. This serves several purposes, some of which include maintaining the integrity of the eye socket, opening the eye, and matching the other healthy eye.