Anophthalmos
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Side Effects / Complications of Enucleation or Evisceration Surgery
When an eye is removed, the patient loses all vision and the cosmetic use of the globe. Described complications include hemorrhage, infection and extrusion of the implant. Most patients with post-operative hemorrhage are either on blood thinners (e.g coumadin, plavix, heparin or aspirin) or are known to have a bleeding disorder. Such hemorrhages can be painful, but intervention is rarely helpful. Patients are typically treated with analgesic medications (pain-killers).
Orbital infections are very rare at Idaho Eyelid and Facial Plastic Surgery, but are more common with integrated orbital implants. Most secondary orbital infections can be managed with antibiotics or surgical removal of the orbital implant. Implant extrusions can be managed by surgical replacement of the orbital implant. Following enucleation there is a decrease in volume as well as changes in structure which give rise to what has been termed “post-enucleation socket syndrome.” This involves enophthalmos, a deep upper eyelid sulcus, lower eyelid laxity with shallow fornix with possibly ptosis or lid retraction.
When an eye is removed, there is an approximate 7 ml volume loss; however, the most commonly used 18 ml sphere replaces a volume of approximately 3 mm while a 16 mm sphere replaces a volume of 2 ml. A 20 mm sphere provides 4.1 ml of volume. The situation is made more complicated by orbital fat atrophy of up to 3 ml. It is unclear whether fat atrophy recurs as a lead to of reduction of blood supply or due to mechanical manipulation during surgical enucleation. Bony orbital volumes are also noted to be smaller in patients who have had long-standing enophthalmia (posterior displacement of the eye).
Note the presence of amorphous tissue and structures resembling extraocular muscles within the anophthalmic right orbit. The right optic nerve/chiasm junction appears attenuated rather than absent suggesting possible residual optic nerve neural tissue.
Potential Complications
Exposed Orbital Implant
The photograph on the left is an exposed orbital implant. The implant, once exposed, is at risk for extrusion. If the exposure is limited, it might be repaired surgically. Otherwise, it may need to be removed and a dermal fat graft procedure may be performed.
Post-enucleation. The condition of Anophthalmic socket (orbit not containing an eyeball but with orbital soft tissue and eyelid structures) can lead to deep sulcus resulting in loss of volume, structural changes, fat atrophy, retraction or changes in extraocular muscles, and/or loss of support of the levator complex.
