Patients can present with conditions that lead to the removal of an eye or the orbital contents in order to safeguard life, to preserve vision in the fellow eye, or to enhance comfort and cosmesis.
The goals of anophthalmic socket surgery are
maximizing orbital implant volume with good centration within the orbit
achieving optimal eyelid contour, volume, and tone
establishing a socket lining with deep fornices to retain the prosthesis
transmitting motility from the implant to the overlying prosthesis
achieving comfort and symmetry
The indications for anophthalmic surgery are diverse, and the procedure of choice varies. Enucleation involves removal of the entire globe while preserving remaining orbital tissues. Evisceration is the removal of the intraocular contents (lens, uvea, retina, and vitreous), leaving the sclera, extraocular muscles, and optic nerve intact. Exenteration refers to the removal of some or all of the orbital tissues, including the globe. The cosmetic goals in anophthalmic surgery are to minimize any condition that draws attention to the anophthalmia. Surgical efforts to produce orbital and eyelid symmetry and to promote good prosthetic position and motility enhance cosmesis.
Congenital anophthalmia (absence of the globe) and microphthalmia (globe diminished in size) and their management are discussed in Chapter 3 in this volume. Management of infants with these disorders differs from management of adults with anophthalmia because of the opportunity for orbital and tissue expansion in infants. However, the principles of socket surgery described in this chapter may also be applied to these children.
Loss of an eye may cause degraded self-image or depression. The ophthalmologist can assist patients both before and after surgery by providing reassurance and psychological support. Discussions of the procedure, the rehabilitation process, and expected functional changes can help patients with adjustment. With very few exceptions, monocular patients may resume the full range of home, vocational, and recreational activities. When resuming full activity, patients should take a cautious approach to allow adjustment to the loss of some depth perception and visual field. This loss may result in occupational limitations. One of the most important roles for the ophthalmologist is to help safeguard the remaining eye through regular follow-up examinations and the prescription of polycarbonate safety glasses for full-time wear.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.