Eye Speciality - Our hospital - Departments

Typical conditions treated at this service include

Oculoplastic surgery
Orbital fractures and trauma
Orbital tumors and cancer
Eyelid and eye socket reconstruction
Evaseration of the eyeball contents and re construction
Enucleation (removal of the eye) and reconstruction after removal of the eye.

Orbital fractures and trauma
The eyelids and the bones of the orbit may be damaged by many types of trauma car accidents, fights, sports injuries, etc. Proper repair of the initial injuries as well as possible needed plastic revisions may be extremely important in restoring the proper protective function and cosmetic appearance of the eyelids and orbital bones.

If the eye is damaged to the extent that it must be removed, an artificial eye (prosthesis) is usually made to fit the empty socket. At times, it may be necessary to perform additional surgical procedure on the socket to make the artificial eye appear more attractive.

Evisceration

in this operation the sergeon remove the contents inside the eye ball with preserving the eye ball coat " the sclera" , and a confirmer ,which is a piece of plastic, is
inserted temporary and kept in the eye to serve as a template for the prosthetic eye to be implanted after few months.

this operation is indicated for the phthitic eye" lost eye" and for the diseased eye which is not seeing, in Eye Specialty Hospital we did many of these operations
last few years mainly for Iraqi patients who were victims of war injuries.

Enucleation
Enucleation refers to the surgical removal of an eye. This procedure is generally recommended only when there is no other choice. Enucleation is usually performed for several different reasons: to remove a malignant tumor that has developed within the eye; to alleviate intolerable pain in a blind eye affected by a condition such as uncontrollable glaucoma; or to reduce the risk of "sympathetic" inflammation of the remaining eye when one eye has been severely injured and blinded.

Removal of an eye is considered a drastic and traumatic measure to most people. Although many patients who require this surgery have no vision in the affected eye, those who do have vision recognize that enucleation will result in instantaneous, permanent, total blindness of that eye. Furthermore, all patients who undergo this procedure will require an artificial eye (ocular prosthesis) as a cosmetic substitute for the real eye.

Surgical Procedure
Enucleation is usually performed under general anesthesia, although it can be done under local anesthesia by numbing the entire eye and socket tissues prior to the surgery. The procedure generally takes no more than 45-60 minutes.

Immediately after the eyeball has been removed, an orbital implant, only slightly smaller than the eye, is inserted deep in the socket. Muscles are attached to the implant to improve motility. The implant is covered externally with conjunctiva, the pink surface tissue that lines the eyelids and is similar to the inner lining of the mouth.

Postoperative Care
At the completion of the enucleation, a pressure patch is applied over the eyelids. This patch is intended to keep swelling of the socket tissues to a minimum. It is generally kept in place for about one to four days after the surgery. During the time this patch is in place, the patient commonly experiences some difficulty opening the lids of the unoperated eye. This can be quite frightening to the patient, who is effectively blind in this situation.

Fortunately, the difficulty in opening the eyelids generally resolves itself after the first post-operative day. Moderate post nucleation pain in the socket generally occurs during the first 24 hours, but pain relievers are usually prescribed as needed to reduce this discomfort.

After the pressure patch is removed, the eyelids are usually swollen and black-and blue for a few days. The use of ice compresses on the eyelids generally helps to reduce the swelling rapidly. Eye drops or ointment which promote healing of the socket tissues are usually started as soon as the pressure patch has been removed.

Orbital Implants and Ocular Prostheses
Following enucleation, the eye is replaced with an orbital implant to fill the empty socket.

The cosmetic artificial eye (ocular prosthesis) is a plastic device that is molded to fit between the eyelids over the conjunctiva that covers the ball implant. This prosthesis is generally made two to six weeks after enucleation, in order to allow the socket tissues time to heal adequately. Prior to that time, a thin plastic plate (conformer) is usually worn in place of the prosthesis. This conformer helps to prevent shrinkage of the space between the inner surface of the lids and the conjunctival covering of the ball implant. Until the ocular prosthesis is fitted, the upper eyelid may be droopy. The prosthesis supports the eyelid and generally allows the lids to open and close normally.

Some of the older implants, such as plastic or silastic, have a natural appearance when the patient looks straight ahead, but do not move like the opposite eye, since they are not integrated.

However, newer types of orbital implants allow movement of the artificial eye. These prostheses are called integrated orbital implants, such as Med pore or hydroxyapatite (Bio-Eye).

Integrated Implants
The newest orbital implants are made of hydroxyapatite (Bio-Eye) or porous polyethylene (Med pore). It is inserted into the patient's orbit immediately following enucleation. The muscles that move the eye are then sutured around the implant. As with other implants, after about four weeks, the ocularist inserts a temporary prosthesis between the eyelids over the implant.

In about six months, when blood vessels have grown into and around the implant, a small hole may be drilled into the implant, so that a peg can be inserted under local anesthesia. (This is done rarely.) The prosthesis is attached to the peg like a ball and socket joint. It transmits the movement of the implant to the overlying prosthesis, so that it moves along with the patient's other eye. The peg also helps to support the weight of the prosthesis, which may prevent the lower eyelid from sagging.

Some tearing of the eye is normal once the prosthesis is in place. In some patients, thick mucus may build up on the prosthesis requiring that the artificial eye be removed and washed off from time to time. In most instances, mucous buildup can be washed off the prosthesis and out of the socket by using an irrigating solution without removing the prosthesis. However, most patients remove their prosthesis for cleaning once every one to three months.

Not all patients are candidates for this type of implant. Your physician will evaluate what is best for you.

Frequently Asked Questions after Evisceration / Enucleation

What will I look like following surgery? Will I have a hole where my eye was?
What is the conformer? What do I do if the conformer comes out?
How do I clean my socket?
When will I get my prosthesis?
Will my prosthesis look like my other eye?
What will I wear between going home and getting my prosthesis?
Will I be able to do everything I did before?
What special adjustments will I have to make?
Do I need to wear eyeglasses?
May I wear makeup?
Will I be able to drive?
May I go swimming?
Is it normal to have mucous or other discharge?

What will I look like following surgery? Will I have a hole where my eye was?
With the eyelids closed, your appearance will be unchanged. When your lids are open, you will see conjunctiva covered by a conformer. Conjunctiva is the pink tissue resembling the mucous membrane inside your mouth. This tissue covers the ball implant which has been implanted in the socket, filling the space created by removal of the eye.

What is the conformer? What do I do if the conformer comes out?
The conformer is a triangular-shaped plastic shell with a central hole and an apex and a base. It will keep the shape of your eyelids until you get your prosthesis. If the conformer does come out, you can put it back in. First wash the conformer under running water. Then point the apex towards the nose, slide the conformer under the upper lid, pull down the lower lid and blink. The conformer will go back into place.

How do I clean my socket?
Special care must be taken with the socket until healing is complete. In the immediate time period after your surgery, the closed eyelid should be wiped gently with a cotton ball moistened with the sterile eye solution given to you when you are discharged; drops or ointment may also be prescribed. This helps to keep the socket free from infection. The healing process usually takes about two to four weeks.

When you receive your ocular prosthesis, you may wash your face normally. When you remove your prosthesis to clean it, wash it under running water. Never use anything else, because it will damage the smooth surface. The ocularist will review the care of your prosthesis with you.

When will I get my prosthesis?
In two to six weeks after your surgery you will be fitted with a temporary prosthesis at the ocularist's office. On your second visit, approximately three weeks later, you will be fitted and receive your permanent prosthesis.

Will my prosthesis look like my other eye?
Yes, the prosthesis looks very natural. The color and appearance are made to match your other eye. The pupil will be of normal size, but will not grow larger and smaller in response to light as it does in the normal eye.

the prosthesis will also be able to move in conjunction with your other eye.

What will I wear between going home and getting my prosthesis?
The conformer will remain in place under the lids. An eye patch will cover the eye. Dark glasses may also be worn.

Will I be able to do everything I did before?
Yes, although you will have to make a few adjustments. You will not have good depth perception or have a full binocular field of peripheral vision.

What special adjustments will I have to make?
Use head movements as fully as possible to compensate for the lack of depth perception and decreased peripheral vision. You have to develop a habit of looking around before you "leap." Learn to use your nose as a pointer.

Do I need to wear eyeglasses?
Your doctor may advise you to wear glasses as an added protection for your good eye.

May I wear makeup?
Yes.

Will I be able to drive?
Yes, you can learn or continue to drive. Licensing standards vary from country to country; however, most countries license drivers with one eye who pass their eye test.

May I go swimming?
Yes, you may go swimming, although goggles or a mask are a good idea. If water skiing or diving, remove your prosthesis first, since it may become dislodged on impact.

Is it normal to have mucous or other discharge?
Yes, most people experience a normal amount of mucous discharge. If the amount increases or changes in color, consistency or develops an odor, then you need to see your ophthalmologist right away to check for any signs of infection.

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