Enucleation frequently asked questions (FAQ’s)
If you need enucleation or evisceration surgery, you are advised to watch this video and read the patient information to help you better understand the surgery and what it is like to have an artificial eye.
Below are some additional answers to questions raised by patients that you may also have. If you have further suggestions for questions you feel would be helpful as part of the FAQ’s, please email marketing@eyeandear.org.au
Before Surgery
How long will I have to wait for my surgery date?
Your operation date is dependent on how clinically urgent it is for you to have your surgery. This is decided by your surgeon after your assessment. When you have agreed to have the surgery and signed your consent form you are placed on the surgical waiting list. You will be given a Heath Questionnaire which you will need to complete and return to the hospital. The Surgical Bookings Unit (SBU) will contact you when a date for surgery has been confirmed. Further information on treatment times for elective surgery can be found in the Victorian Governments Elective Surgery Access Policy.
When do I need to stop eating, drinking and taking medications before my surgery?
Before surgery you will either attend a preadmission clinic or have a preadmission phone call. Staff will provide you with fasting information and instructions about which medications you can and cannot take before your surgery. It is important that you tell the staff about any medications you take including supplements, natural or alternative medications. It is especially important that you discuss any anticoagulation / antiplatelet (blood thinning) medication or medication for diabetes.
Do I need someone to accompany me on the day of surgery?
It is natural to experience nervousness and anxiety on the day of surgery and it is a good idea to have a support person who can stay with you until you go to theatre for your surgery.
What should I bring to hospital?
Most patients who have this procedure only stay one night. Bring a small overnight bag with loose fitting night and day wear and toiletries for 1 to 2 nights. Bring all medication in original packaging. Jewellery (apart from a wedding ring) and cash should not be brought to the hospital.
The procedure
How long does the surgery take?
This procedure usually takes 1 to 2 hours and in most cases it is done under general anaesthetic. You will be away from the ward for 3 to 4 hours as time is also required for anaesthetic preparation before surgery and recovery time after surgery.
How is the existing eye removed and the artificial one attached?
For enucleation surgery the eye muscles and optic nerve are cut to allow the unhealthy eye to be removed from the socket. A variation of this surgery is evisceration where only the contents of the eye are removed, leaving the white part of the eye (the sclera) and the eye muscles intact. A small round implant replaces the tissue volume lost and for enucleation where possible, the eye muscles are connected to the round implant. The implant is then covered in the patient’s own conjunctiva tissue. A thin plastic shell called a conformer may be placed in the socket after surgery to help reduce swelling. Following surgery, the surface of your eye socket will look similar to the back of your lip. Some patients may also have the eyelids stitched together for a week or two to help reduce swelling. After a healing period of 6 to 8 weeks the artificial eye can be made and worn. The artificial eye can be removed and replaced easily. The implant is fixed and can only be removed surgically.
Can you have an enucleation or evisceration and not have the ball implant?
If there is severe infection at the time the unhealthy eye is removed a ball implant may not be recommended. If this does occur an implant can usually be put in at a later date and this is called a secondary implant. Without an implant an artificial eye that is fitted will look sunken with a deep hollow under the eyebrow. The artificial eye would be larger and heavier which would put pressure on the lower eyelid causing sagging of the eyelid.
After surgery
How long should it take for my wound to heal?
After your operation you will have a pressure bandage and pad covering the socket. This is removed 1 to 7 days after surgery. Some patients may have some stitches to keep the eye lids closed which are removed at your first post-operative appointment. Once the pressure bandage is removed antibiotic drops or ointment is applied to the lids or socket. This is usually for one week and you may need someone to help you with these. It takes about 6 to 8 weeks for all the swelling to subside.
How long will I be in hospital?
Many patients only stay in hospital for one night following enucleation /evisceration surgery, but you may need to stay two nights or more.
Will I have any pain?
With all surgeries there can be some pain. It is important to tell nursing staff as soon as you experience pain so you can take appropriate medication to reduce it. Movement of the remaining eye will cause the implant to move and this can cause some discomfort due to the swelling from the surgery and movement against the conformer if placed in the socket. Taking regular pain medication, resting and minimising eye movement of for the first few days at home will also help to control pain after surgery. Also avoid watching TV or reading for the first few days after surgery.
Can I get an infection with my implant?
Infection after enucleation and evisceration surgery is rare. Often antibiotic drops or ointment are prescribed for the socket after surgery, which help prevent infection.
Will I need other surgery or treatment?
There are few complications following enucleation or evisceration surgery. The most common complications relate to drooping of the upper eye lid or the appearance of a sunken eye which may require corrective surgery.
What should I do if the conformer comes out?
The conformer is not stitched in when placed in the socket after surgery and it may come out. There is no need for concern if this occurs. If you do not feel comfortable replacing the conformer yourself you can contact your eye doctor or hospital for advice on whether the conformer needs to be put back in.
How long before I can return to work?
It is important to rest after your surgery. This will assist with healing and pain management. You may require up to two weeks off work. If you feel you require longer, this can be discussed with your eye doctor or GP.
How long before I can drive?
Having only one eye does not prevent you from driving provided the remaining eye has the level of vision required by the authorising body in your state. In the state of Victoria it is required that you notify Vic Roads regarding any medical conditions, injury or illness that may impair your ability to drive safely. When it is safe to drive will depend on the level of sight in your remaining eye and the period of time you require adjusting to seeing with one eye. It can take 3 to 6 months to adjust to having vision in only one eye. This is often less if the vision had already deteriorated in the unhealthy eye that was removed.
Artificial eye
How is the artificial eye made?
Your artificial eye is made 6 to 8 weeks after surgery to allow for the swelling to subside. An Ocularist is the person who makes artificial eyes. The Ocularist will take an impression of your socket and use this to shape your artificial eye so it will fit perfectly. It is important to remain very still when the impression is being made as this will ensure the best fit of your artificial eye. Having the impression made is not painful but it is an unusual sensation of pressure and mild irritation but this only has to be tolerated for a few minutes. After the impression, time is spent accurately matching the colour of the artificial eye to your real eye.
When complete the artificial eye is like a thick contact lens that sits over the covered implant from your surgery. It is held in place by the way it is fitted to your socket and the muscles of your eye lids. The artificial eye is made from acrylic which is both light and strong.
How long does it take to make it?
Most artificial eyes can be made over two sessions with the Ocularist. The first session is where the impression of the socket is taken and colouring of the iris is made and can take up to two hours. The second session is a fitting where adjustments to the shape and colouring of the artificial eye are made and most patients are able to wear the artificial eye from this point. The second session is a week or two later and can be up to an hour.
How much does an artificial eye cost?
An artificial eye costs approximately $1800. For public patients the first artificial eye made after the initial or subsequent surgery is covered by Medicare. Replacing a lost or old artificial eye is paid for by the patient.
For private patients the out of pocket payment and frequency for replacement is dependent on your health cover provider and the level of cover you have. Your Ocularist will be able to assist you with the item number relevant to cover an artificial eye with your health fund.
How often should I replace my artificial eye?
As a general rule your artificial eye should be replaced every five to ten years. Shorter replacement periods can be required if the artificial eye becomes uncomfortable to wear, there are complications with the health of the socket or additional surgery is required. Annual check-ups with your Ocularist to have your socket inspected and have the artificial eye checked and polished will assist with the comfort of the artificial eye and enable the Ocularist to advise when a replacement is required.
Will the artificial eye fall out?
The artificial eye is made from an impression of your socket to maximise the fit. The artificial eye should not fall out or feel loose in the socket. You should contact your Ocularist if this occurs.
Is it hard to insert and remove the artificial eye?
Removing and inserting the artificial eye is not difficult but it does require practice. Your Ocularist will be able to instruct you on how this is done.
How often do I remove the artificial eye?
The artificial eye is removed when required, usually for cleaning or to inspect the socket. If the socket feels slightly irritated cleaning the artificial eye and socket with normal saline can help. Irritation of the socket can be caused by protein build up on the artificial eye from moisture. Soaking the artificial eye in a hard contact lens solution overnight will break down the protein build up so the eye is more comfortable to wear.
Can I cry with an artificial eye?
Tears are produced by the lacrimal gland. This gland is located under the skin just below the eyebrow and is not removed with this procedure. You will continue to produce tears and can cry with an artificial eye.
Can I see with my artificial eye?
This may seem a silly question and most patients understand they cannot see with an artificial eye. The question more often comes from other people who may not understand the nature of the surgery to remove the eye and the nature of the artificial eye, which of course cannot see.
Living with an artificial eye
What does wearing the artificial eye feel like?
At first the artificial eye can feel a little uncomfortable with a sensation that it is too big for the socket. For some people this sensation can take several days to subside. The socket may be watery when first wearing the artificial eye but should also settle after a few days.
A small amount of white to yellowish mucus discharge is a natural occurrence when wearing your artificial eye. This is produced by the friction of the artificial eye when worn and can be in larger amounts when first wearing your artificial eye. This discharge usually collects in the inner corner of the eye and can be easily and discreetly removed with a clean tissue or cotton bud.
The artificial eye can at times feel dry. This can be due to environmental reasons, such as air conditioning, home heating or wind and can be relieved by using over the counter lubricating eye drops.
It can take up to three weeks before wearing your artificial eye feels completely comfortable and the watering and discharge begin to settle. Then you should have minimal to no noticeable sensation.
How much movement will I have with an artificial eye?
If your surgeon was able to connect the eye muscles to the ball implant you will have some movement of the artificial eye. At first this may feel unusual but not painful. After a few days you should not notice any sensation with this movement. The range of movement achieved varies for each patient but you will not have the full range of movement as the remaining eye. Your Ocularist will be able to advise you how to maximise the natural appearance of your artificial eye.
What is the impact of living with one eye?
The main impact is reduced depth perception. This is especially apparent if vision loss in one eye has been sudden. At first simple tasks such as shaking hands, pouring drinks, tracking objects or navigating crowds will be challenging as the brain normally uses the vision from both eyes to assist with these tasks. Your brain will adapt over three to six months to only seeing with one eye and judging distances will improve.
The loss of vision in one eye will reduce peripheral vision on the affected side by about 20% to 30%. This is important to remember when crossing roads or driving as you will need to turn your head more to have a wider view of your environment.
Having an artificial eye should not prevent you from doing anything you would normally do with vision in both eyes. Your artificial eye is worn while you sleep shower, run, swim, play sport and work. Some daily activities like shaving or applying makeup and some work tasks may take a bit longer or may require a bit more concentration at first but will become easier as you adjust to having vision in one eye only. With any activity or task, it is very important that you protect the remaining sighted eye by wearing protective eye wear if there is any risk of injury to this eye or vision loss.
What about emotional and mental health support after surgery?
You should talk to someone about any emotional concerns you have or experience due to your vision loss or artificial eye. If you are concerned about mental health issues you experience, such as loss of self-esteem, fear and anxiety you should raise this with your General Practitioner (GP). Your GP can assist with creating a treatment plan which can include up to 10 sessions per year with a registered mental health professional under Medicare.
Can a patch be worn instead of an artificial eye?
Choosing to wear a patch instead of an artificial eye in most cases does not cause any problems. The eye socket maintains its shape and size, and the socket can be fitted later with an artificial eye if you change your mind. In some patients (not many) the eye socket will shrink and make fitting and wearing of an artificial eye difficult or even impossible in the future. Also, there tends to be more tears and mucus accumulating in the socket and discharging when an artificial eye is not worn.
Do I need to update my passport photo?
Unless there are significant changes to your physical appearance there is no requirement to change a passport photograph. If traveling internationally while wearing an eye patch it is advised to have a letter from your doctor explaining why the patch has to be worn. If you have any concerns regarding your passport you can contact the Australian Passport Information Service.
Where can I find more information?
There is a factsheet and videos in the Patient and Visitors section on the Eye and Ear website.
artificialeyes.net
Moorfield’s Hospital Videos
EyeRounds.org (WARNING – Contains surgical images)
Ocularist Association of Australia
EyeMelanoma.org
The Eye Cancer Foundation
A Singular View
This information has been put together from a project which was generously funded by WAEH which gathered feedback from over 150 patients who have had an eye removed at The Royal Victorian Eye and Ear Hospital, Australia, Moorfields Eye Hospital NHS, UK and Kellogg Eye Centre, USA.
