Enucleation: Removing your child's eye

Enucleation is surgery (an operation) to remove an eyeball.

Your child may need an enucleation if, for example:

  • an eye has cancer
  • there is unbearable and uncontrollable pain in an eye that is blind
  • a severely injured eye is causing problems and has no chance of seeing again.

Doctors will only do an enucleation after they have tried everything to save your child's eye and it is the safest option.

Before any procedure, it is important to talk honestly with your child about what will happen and to use language that they will understand. Children feel less anxious when they know what to expect.

What happens during enucleation surgery?

The surgery will remove your child's eyeball and replace it with a temporary prosthetic (fake) eye. For the surgery, your child will receive a general anaesthetic. This is a mix of medicines that helps your child fall into a deep sleep. Your child will not feel pain or remember the operation.

During the surgery, the surgeon will remove your child's eyeball from their eye socket. The eye socket is the bony area that holds and protects the eyeball. The doctor will be careful to preserve all normal tissue (muscles and nerves) around the eye.

Next, the doctor puts in an orbital implant. This is a solid "ball" that fills the space left behind by the eyeball. The implant will help your child's custom-fitted eye look more natural.

You will not see the orbital implant because it is covered by other tissues. The muscles that move the eye will be sutured (stitched) to the implant or to the corner of the eyelids. Attaching the eye muscles to the implant or the corners of the eyelids will help your child's new custom-fitted eye to move a little when it is in place.

At the end of the surgery, the doctor will put a temporary prosthetic (fake) eye under the eyelid. The fake eye is an oval piece of plastic that has an eye painted on it. It looks like a big contact lens. It helps the eye socket keep its shape and heal properly.

Your child will wear the temporary prosthetic eye all the time until they are ready to get their custom-fitted eye. This usually happens about six to eight weeks after surgery. This eye will lie just over the tissue that covers the orbital implant.

What happens right after enucleation surgery?

Eye patch

After the surgery, your child will wake up with an eye patch taped tightly over the closed eyelid. This patch is called a pressure patch and helps to keep the swelling down. Your child's other eye will not be covered.

Your child might be upset after the surgery because they need to wear the patch. Comfort your child and remind them that they will need the patch for about two days. Your child will likely stay in hospital during this time.

Swelling and bruising

Your child's eye socket will be swollen. The swelling can sometimes spread and cause problems opening the other eye.

Your child may be scared if they cannot open their other eye. Comfort and reassure your child. They will be able to open both eyes when the patch comes off.

After the patch comes off, your child's eyelids may still be swollen. As a result, your child may not be able to open the eye at first. This is normal and will improve gradually.

The area around the eye may be bruised, making it seem that your child has a black eye. Bruising like this can take several weeks to go away, just like any bruise. It is likely to change through several colours.

If you are worried, ask the doctor or nurse for support.

Pain

Some children have a little pain after the surgery. Other children might not have any pain.

If your child complains of a lot of pain, ask your nurse or doctor if they can have something to ease it.

Mucus

Your child may have some mucus draining from the socket where the eye was removed. This may be thick and sticky or runny. The mucus is normal when it is white, slightly pink (blood stained) or yellow. It will stop in a few days.

When to see a doctor

Call your child's doctor right away if:

  • the amount of mucus increases
  • the mucus changes to a greenish colour
  • the mucus gets thicker
  • the mucus starts to smell
  • your child's eye is weepy, painful or very red around the eyelids
  • the eyelid becomes more swollen
  • your child has a fever.

Caring for your child's eye socket

You must take special care of your child's eye socket until it is completely healed. When the socket is healed, it will not need special care.

Right after the surgery, your child's eyelids may be sticky and hard to open because of mucus draining from the eye. It is very important that you keep your child's eye socket clean while it is healing. Always wash your hands before and after you touch your child's eye.

Cleaning your child's eye

  1. Fill a container with warm clean water. Make sure the water is not so hot that it will burn you or your child.
  2. Wet a cotton ball, a piece of gauze or a clean face cloth with the warm water.
  3. Gently wipe the closed eyelids.

If the eyelids are very sticky, leave the damp cotton ball, gauze or face cloth over the eyes for a short while (up to five minutes). This will help make the mucus softer and easier to remove.

It is fine for your child to take a shower or bath as they start healing from surgery, but they should avoid water-based activities such as swimming until the eye is healed and their custom-fitted eye is in place. This usually happens about six weeks after surgery.

Will my child need any medicine after surgery?

Your child will need medicine to help the eye heal and prevent infections. Your child's doctor will order eye drops or eye ointment.

You will need to apply the eye drops or ointment​ for about six to eight weeks while the eye heals.

How long will my child wear the temporary prosthetic eye?

Your child will need to wear the temporary prosthetic eye for about six weeks while the eye socket heals. After this time, your child will get their custom-fitted eye​.

Will my child still be able to make tears?

Even though your child has a prosthetic eye, the tear glands will still work. If your child's eye lid has not been damaged, tears will flow normally.

Will my child's other eye need any special protection?

Your child's other eye needs to be protected at all times. Wearing special eyeglasses with shatterproof lenses will protect it.

If your child wore eyeglasses before the operation, the lens over their "good" eye will be the strength your child needs to see clearly. Even if your child does not need eyeglasses to see clearly, the doctor will give you a prescription for "neutral" or "powerless" lenses to protect the good eye. Your child's doctor will tell you when your child should wear these eyeglasses.

Key points

  • Enucleation is surgery to remove a diseased or damaged eyeball.
  • Your child will wear a temporary prosthetic eye for the first six weeks after surgery while the eye socket heals. Then your child will get a custom-fitted eye.
  • You will need to keep your child's eye socket clean and put medicine on it while it is healing.
  • Call the doctor if you see signs that the eye is infected, such as a change in the look or amount of mucus, a bad smell, redness, pain or fever.
  • Your child will need to wear eyeglasses to protect their good eye.

Beverley Griffiths, RN

Brenda Gallie, MD

Elise Heon, MD

Dan DeAngelis, MD

7/24/2014




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