- 0.5 forceps and/or Bishop-Harmon forceps
- Muscle hook
- Castroviejo needle driver
- Bipolar cautery
- 11 blade
- Mosquito hemostat or bulldog/Serrafine clips
- Wescott and Stevens' tenotomy scissors
- Sponges and cotton tipped applicators
- Thrombin, local anesthetic, or cocaine: can soak sponges and apply for local hemostasis
- Evisceration spoon
- Implant (see section on enucleation)
- 6-0 plain gut
- 5-0 or 6-0 polyglactin
- 4-0 silk
(Nerad, Oculoplastic Surgery, The Requisites. St. Louis: Mosby, 2001)
- Evisceration can be performed with or without removal of the cornea.
- If the cornea is healthy, it can be preserved:
- Conjunctival periotomy with Wescott scissors, dissecting only a few millimeters posterior to the limbus
- The superior rectus is tagged and disinserted from the globe as described for enucleation
- An incision through the sclera is made posterior to the superior rectus insertion
- The intraocular contents are removed
- An implant is placed (see implants section above)
- Scleral wound is closed
- Superior rectus is reattached to its insertion
- If the cornea will not be preserved:
- Conjunctival peritomy with Wescott scissors, dissecting only a few millimeters posterior to the limbus
- Initiate a keratectomy by making a stab incision through the cornea at the limbus
- Complete the keratectomy by making a full-thickness, 360‑degree limbal incision through the cornea and remove it with toothed forceps.
- Remove the intraocular contents with an evisceration spoon by inserting the spoon between the choroid and sclera to deliver the intraocular contents
- The interior of the scleral shell can be scraped with a blade and scrubbed with 100% alcohol to remove all visible uveal tissue remnants (Huang, Am J Ophthalmol 2009)
- Posterior scleral relaxing incisions are usually required to place a 20–22‑mm implant, without tension on the imbricated scleral closure
- Place an implant (see implants section above)
- Relaxing incision might be necessary to fit the implant through the anterior opening in the sclera
- Close the wound in 3 layers:
- Overlap the edges of the sclera and close with sutures, e.g., 5‑0 polyester or polyglactin in a horizontal mattress fashion
- Pull the edges of Tenon's capsule together and close with interrupted 5‑0 polyglactin suture
- Close the conjunctiva with a running absorbable suture, e.g., plain gut or polyglactin
- Place topical antibiotic and conformer in the conjunctival fornix
- Consider temporary suture tarsorrhaphy
- Consider pressure patch
Figure 1. Evisceration. Courtesy Brett Davies, MD.
Figure 2. Evisceration. Courtesy Rona Z. Silkiss, MD, FACS.
Figure 3. Evisceration. Courtesy Rona Z. Silkiss, MD, FACS.
Figure 4. Evisceration. Courtesy Rona Z. Silkiss, MD, FACS.