The emotional distress which frequently accompanies the removal of an eye is reduced considerably by a cosmetic final result. The appearance of the prosthesis will be enhanced and its mobility will be improved if a buried orbital implant is inserted (see Ch. 13 ) following an evisceration or enucleation.
Evisceration with removal of the cornea
Identify the optic nerve head. Cut around it to separate it from the remaining sclera. A Colorado cutting diathermy needle or a Surgitron (Ellman) radiofrequency needle is a convenient instrument for this but a scalpel may be used instead.
Place a 22 mm sizer (see Figs 5.13 , 13.1aA ) or acrylic ball ( 13.1aB ) into the scleral envelope to check that it can be accommodated. Using an introducer, if available, insert the implant into the sclera, ensuring that it is placed well posteriorly, within the posterior sclera and anterior intraconal fat.
Close the sclera over the implant with 6/0 absorbable sutures. If any of the ball is exposed place a patch of donor sclera over the repair (see 13.10 ).
Chemosis and lid oedema are common after evisceration. Providing infection does not occur the swelling will settle without treatment.
The risk of sympathetic ophthalmitis in the fellow eye is extremely small but during the follow-up period the fellow eye should be examined.