2020–2021 BCSC Basic and Clinical Science Course™
7 Oculofacial Plastic and Orbital Surgery
Part I: Orbit
Chapter 8: The Anophthalmic Socket
Enucleation and Evisceration
Evisceration involves the removal of the contents of the globe, leaving the sclera, extraocular muscles, and optic nerve intact. Evisceration should be considered only if the presence of an intraocular malignancy has been ruled out.
Advantages of evisceration
The advantages of evisceration include the following:
Less disruption of orbital anatomy. Because there is less dissection within the orbit, there is a lower chance of injury to the extraocular muscles and nerves and a lower chance of fat atrophy. The relationships between the muscles, globe, eyelids, and fornices remain undisturbed.
Better motility of the prosthesis. The extraocular muscles remain attached to the sclera.
Treatment of endophthalmitis. In cases of endophthalmitis, some surgeons prefer evisceration, because the ocular contents can be extirpated and drained without invasion of the orbit. The chance of contamination of the orbit and possible subsequent orbital cellulitis or intracranial extension is therefore theoretically reduced.
A technically simpler procedure. Performing this less invasive procedure may be important when general anesthesia is contraindicated or when bleeding disorders increase the risk of orbital dissection. Because evisceration requires less manipulation of the orbital contents, less anesthetic sedation may be necessary.
Lower rate of migration or extrusion of the implant, and subsequent reoperation.
Easier prosthesis fitting by the ocularist.
Disadvantages of evisceration
The disadvantages of evisceration include the following:
Not every patient is a candidate. Evisceration should never be performed if a malignant ocular tumor is suspected. Severe phthisis bulbi limits the size of the orbital implant that can be placed unless posterior sclerotomies are performed.
Theoretical increased risk of sympathetic ophthalmia. Early reports, however, have not been confirmed.
Evisceration affords a less complete specimen for pathologic examinations.
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.