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Evisceration & Eneucleation

The document outlines two surgical procedures: evisceration and enucleation, detailing their definitions, indications, contraindications, preoperative assessments, techniques, complications, advantages, and disadvantages. Evisceration involves the removal of the globe's contents while preserving surrounding structures, whereas enucleation entails the complete removal of the globe. Both procedures are indicated for various ocular conditions but carry risks and require careful patient assessment.

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himanshi.sharma02468
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52 views24 pages

Evisceration & Eneucleation

The document outlines two surgical procedures: evisceration and enucleation, detailing their definitions, indications, contraindications, preoperative assessments, techniques, complications, advantages, and disadvantages. Evisceration involves the removal of the globe's contents while preserving surrounding structures, whereas enucleation entails the complete removal of the globe. Both procedures are indicated for various ocular conditions but carry risks and require careful patient assessment.

Uploaded by

himanshi.sharma02468
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

EVISCERATION

DEFINATION

• Surgical technique

• Removal of the contents of the globe

• Leaving behind the sclera , EOM, fat and other adjacent ocular structure intact

• Need for an orbital implant after surgery.


INDICATIONS

• Endophthalmitis

• Painful blind eye

• Bleeding anterior staphyloma

• Penetrating ocular trauma

• Expulsive choroidal haemorrhage


CONTRAINDICATION

• Absolute - Intraocular Malignancy


• Relative – Phthisis bulbi
PREOPERATIVE ASSESMENT

• Proper diagnosis

• Patient councelling

• Haematological Investigations

• Consent

• Pre operative antibiotics

• Selection of anaesthesia
TECHNIQUES

360 degree conjunctival peritomy

Full thickness incision is made at the limbus

Cornea is excised in a circumferential manner

Intraoccular contents are removed

Contents sent for HPE examination


TECHNIQUES
Sclera is swabbed with absolute alcohol
Uveal tissues denatured with absolute alcohol

Haemostasis achieved with direct pressure

Best implant size is selected and implanted

Anterior sclera, Tenon’s capusule and conjunctiva stitched in layers

Eye patched
COMPLICATIONS

• Dissemination of unexpected neoplasm

• Bleeding

• Orbital oedema

• Extrusion of implant

• Infection
ADVANTAGES

• Short surgical time

• Inexpensive

• Simple procedure

• Less disruption to surrounding orbital tissue

• Less painfull
DISADVANTAGES

• Destructive Procedure

• Not every patient is a candidate

• Risk of dissemination of tumours

• Risk of sympathetic ophthalmitis


ENUCLEATION
DEFINATION

• Surgical removal of the entire globe and its contents

• EOM, fat and adjacent ocular structures preserved

• Part connecting globe to optic nerve is cut off


INDICATIONS

• Eye donation

• Intraocular malignancy

• Phthisis bulbi

• Trauma

• Sympathetic ophthalmitis

• Endophthalmitis
PREOPERATIVE ASSESSMENT

• Patient councelling

• Consent

• Haematological assessment

• Eye to be operated is marked

• Anaesthesia
TECHNIQUE

360 degree conjunctival peritomy

Blunt dissection of subtenons space is carried out

Extraocular muscles are identified and isolated with muscle hook

Secured with double armed 6-0 vicryl

Cut at the point of insertion to the globe leaving behind the stamp
with traction suture
TECHNIQUE
When the globe is freely mobile, Optiv Nerve is traced at the back

Strummed and cut with a enucleation scissor( with a single cut )

Haemostasis is achieved by direct pressure

Needles of double armed recti sutures passed through respective


fornices and tied on anterior surface of cojunctiva
TECHNIQUE
Appropriate size implant is placed

2 layered closure with 6-0 vicryl

Conformer is placed

Eye is patched
4-8 weeks post operatively patients are reffered to an ocularist for
fitting of prosthetic eye
COMPLICATIONS
• Haemorrhage
• Infection
• Damage to extraocular muscle
• Wound dehiscence
• Extrusion of conformer
• Extrusion of implant
• Migration of implant
• Socket contracture
• Poorly fitted prosthesis
ADVANTAGE
• Useful in cases of intraocular tumours
• Allows histological examination of entire eyeball
• Decrease chance of sympathetic ophthalmitis

DISADVANTAGE
• Ocular motility is less preserved here.
THANK YOU

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