(Evisceration of the Globe)
Evisceration of the globe involves removing the entire contents
of the eye including the cornea. Placement of an intraocular
implant for orbital volume enhancement would be the eye surgeon's
option. If an implant is inserted into the scleral
husk it would be lesser in bulk than the contents removed,
because of the purse string closure in the absence of the
cornea. (A consensus of ASO members expressed 'evisceration'
cases as their second preference for fitting an ocular prosthesis.
The first choice being the 'scleral cover shell over a dysfunctional
globe. The reason being, the extraocular muscles (rectus
and obliques) will remain attached to the sclera and will
respond accordingly to movement of the sighted eye.
The prosthesis would be similar in thickness to that fitted
over a shrunken globe.) In rare cases where the cornea
is retained, a large as possible spherical ocular implant
would be required, this unfortunately results in the eviscerated
globe's surface to be too smooth of a curvature to transfer
all of its mobility to an overlying thin scleral prosthesis.
Contraindication to performing an evisceration still remains
between ophthalmologists over the possibility of a hidden
tumor developing within the sclera at a later date, or sympathetic
ophthalmia that could effect the remaining eye. (An
oft cited statistic reports it could affect 1 in every 10,000
The two simple evisceration cases presented here were diagnosed
with blind and painful eyes where the entire orbital contents
and the corneas were removed. Instead of an intraocular
implant being placed, a strip of gauze was packed into the
scleral husk and removed several days post-operatively.
It left the scleral remnants gnarled, permitting the posterior
surface of the prostheses to cling to the sclera husks like
glove over fingers. It is of interest so show the post-operative
results after several years how one scleral husk (Fig. 14)
remained unchanged, whereas, the other (Fig. 15) showed closure
plus a loss of orbital fat (adipose) in the superior sulcus.
The evisceration (without implant) resulted in a well pronounced
and firm scleral stump. This allowed the impression
fitted prosthesis to fit snuggly over the irregular contour.
Frontal gaze with the full thickness prosthesis restored
Figures 14C, D,
The following three photos show the extent of motility in
the horizontal plane and upward gaze.
As an added cosmetic measure when prescription eyeglasses
are a necessity, it is advisable to have a similar power
lens on the prosthetic side for balance.
Early post-operative results of the evisceration shows symmetry
in the anatomical adnexa even with a temporary prosthesis
over the eviscerated right eye.
This close up view taken one month post-operative shows a
well pronounced scleral husk that easily accommodated a modified
impression prosthesis that fit snugly into the scleral fissure.
The posterior view of the ocular prosthesis shows the peg-like
extension that adapted to the scleral husk. The motility
of the prosthesis (not shown) was excellent.
Two and a half years later this unanticipated change in the
structure of the eviscerated globe required a re-impression
for the posterior surface of the prosthesis.
Post adjustment shows the superior sulcus to have a depression
supra-nasally between the upper eyelid and the eyebrow that
would not allow for any further correction (with the prosthesis).
However, cosmetic makeup did improve the appearance compared
to how patient appeared 2½ years earlier.