• Usiwoma Abugo
  • Kimberly Cockerham


Orbital exenteration was first described by Georg Bartisch in 1583. Exenteration involves the removal of all orbital contents including fat, nerves, periorbital, conjunctiva, lacrimal sac, lacrimal gland, globe, and conjunctiva. Depending on the extent and focus of the tumor, part or all of the eyelids and varying amounts of the surrounding skin and bone may also need to be removed. This procedure is routinely reserved for potentially life-threatening malignancies or progressive conditions that are unresponsive to other treatments. Less commonly, this procedure may aide in palliation of severe deformity, pain, or unrelenting infection.

Exenteration is a psychologically and anatomically disfiguring procedure. Prior to proceeding with this procedure, an extensive discussion with the patient and the family is indicated. In many cases, involvement of the primary care physician and oncologist (or infectious disease specialist if applicable) is helpful. Alternatives should be discussed including subtotal exenteration, radiation, chemotherapy, and the risk of not proceeding with exenteration. Intracranial imaging, lymph node dissection, and laboratory evaluation should be performed to confirm the malignancy is isolated to the orbit prior to scheduling this surgical procedure. Informed consent should include why the procedure is indicated, what the procedure involves, potential risks, and proposed reconstruction.


Orbital exenteration Orbital tumors Orbital reconstruction Orbital surgery Total exenteration Subtotal exenteration Invasive orbital tumors Orbital tumor management Periocular skin cancer Orbital infections Orbital trauma Congenital deformities 

Supplementary material

419986_5_En_46_MOESM1_ESM.mp4 (240.8 mb)
Video 46.1 Exenteration with placement of a split-thickness skin graft. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 246570 kb)
419986_5_En_46_MOESM2_ESM.mp4 (103.2 mb)
Video 46.2 Split-thickness skin graft. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 105692 kb)
419986_5_En_46_MOESM3_ESM.mp4 (149.4 mb)
Video 46.3 Lid-sparing exenteration. Courtesy of Richard C. Allen, MD, PhD, FACS. (MP4 152934 kb)
Video 46.4 Exenteration in patient with large adenoid cystic carcinoma. Courtesy of Richard C. Allen, MD, PhD, FACS. (MPEG 250292 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Usiwoma Abugo
    • 1
  • Kimberly Cockerham
    • 2
  1. 1.Department of OphthalmologyCentral Valley Eye Medical GroupStocktonUSA
  2. 2.Department of OphthalmologyStanford University, Central Valley Eye Medical GroupStocktonUSA

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