Enucleation

Yesterday (8/1/06) I watched and participated in an enucleation for the first time in my life. It was pretty crazy. =) Here’s the story. A middle-aged man who is completely blind in his right eye was having severe pain in that eye and wanted it removed, so he was scheduled for an enucleation.

Here is a picture diagramming the steps in an enucleation:

Let me explain in layman’s terms what my senior ophthalmology resident did, as it was slightly different from the enucleation pictured above.

The attachment of the conjunctiva was carefully cut from the globe of the eye. Then, all four rectus muscles were isolated and removed from their attachments the eyeball. After that the cornea was cut out and all the intraocular contents were removed (all the fluid inside the eye came gushing out, then he removed the iris, ciliary body, retina, etc.). The optic nerve was severed, and the ophthalmic artery was subsequently cauterized. At this point the eyeball was freed from the eye socket and now looked like an empty white bag with just the scleral shell remaining. It was thoroughly cleaned out and soaked in an antibiotic solution (Ancef). The shell was flipped inside out, placed like a finger puppet on the tip of the resident's thumb, and cleaned out even more thoroughly with absolute alcohol. Finally, a silicone ball was popped inside the shell, which was then closed up with some strong suture. The combination of the sceral shell and silicone ball (making up the new eyeball) was placed back in the orbit, the extraocular muscles were reattached to it, and the conjunctiva was sewn back together over the eyeball. The eyelids were also sewn together temporarily to prevent the eyeball from popping back out.

This was truly a fascinating case. I even got to scrub in at the very end, so that was fun. =) Eyes are amazing. I am very thankful I have two of them. =)