Enucleation, Evisceration, Orbital Implants, and Management of the Irradiated Socket

  • Miguel Gonzalez-Candial
  • Aaron Savar
Part of the M.D. Anderson Solid Tumor Oncology Series book series (MDA, volume 6)


Removal of an eye is sometimes necessary in the management of ocular malignancies. The most common intraocular malignancies necessitating enucleation are uveal melanoma in adults and retinoblastoma in children. In patients with retinoblastoma, the segment of optic nerve removed during enucleation must be long enough to ensure that the entire tumor has been removed. A number of different types of orbital implants are available, each with advantages and disadvantages. Radiation can cause atrophy and contraction of orbital tissues; thus, management of the socket in patients who have undergone radiation therapy is challenging. There is considerable debate over the benefits of enucleation versus evisceration. Evisceration is not appropriate in patients with intraocular tumors as it may leave tumor behind. Before evisceration is performed for an indication not related to cancer, the eye should be carefully examined to rule out the presence of intraocular tumor.


Optic Nerve Uveal Melanoma Extraocular Muscle Sympathetic Ophthalmia Orbital Volume 
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  1. 1.
    Custer PL, Kennedy RH, Woog JJ, et al. Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology. Ophthalmology 2003;110(10):2054–61.Google Scholar
  2. 2.
    Magramm I, Abramson DH, Ellsworth RM. Optic nerve involvement in retinoblastoma. Ophthalmology 1989;96(2):217–22.PubMedGoogle Scholar
  3. 3.
    Abramson DH, Ellsworth RM. The surgical management of retinoblastoma. Ophthalmic Surg 1980;11(9):596–8.PubMedGoogle Scholar
  4. 4.
    Shields JA, Shields CL, De Potter P. Enucleation technique for children with retinoblastoma. J Pediatr Ophthalmol Strabismus 1992;29(4):213–5.PubMedGoogle Scholar
  5. 5.
    Havre DC. Obtaining long sections of optic nerve at enucleation. A new surgical technique based on the anatomy of the posterior fascia bulbi. Am J Ophthalmol 1965;60:272–7.PubMedGoogle Scholar
  6. 6.
    Myers RH. Revaluation of the snare technique for enucleation. Am J Ophthalmol 1950;33(7):1143–4.PubMedGoogle Scholar
  7. 7.
    Schiedler V, Dubovy SR, Murray TG. Snare technique for enucleation of eyes with advanced retinoblastoma. Arch Ophthalmol 2007;125(5):680–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Rubin PA, Popham JK, Bilyk JR, et al. Comparison of fibrovascular ingrowth into hydroxyapatite and porous polyethylene orbital implants. Ophthal Plast Reconstr Surg 1994;10(2):96–103.PubMedCrossRefGoogle Scholar
  9. 9.
    Remulla HD, Rubin PA, Shore JW, et al. Complications of porous spherical orbital implants. Ophthalmology 1995;102(4):586–93.PubMedGoogle Scholar
  10. 10.
    Nunery WR, Heinz GW, Bonnin JM, et al. Exposure rate of hydroxyapatite spheres in the anophthalmic socket: histopathologic correlation and comparison with silicone sphere implants. Ophthal Plast Reconstr Surg 1993;9(2):96–104.PubMedCrossRefGoogle Scholar
  11. 11.
    Li T, Shen J, Duffy MT. Exposure rates of wrapped and unwrapped orbital implants following enucleation. Ophthal Plast Reconstr Surg 2001;17(6):431–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Colen TP, Paridaens DA, Lemij HG, et al. Comparison of artificial eye amplitudes with acrylic and hydroxyapatite spherical enucleation implants. Ophthalmology 2000;107(10):1889–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Lyle CE, Wilson MW, Li CS, et al. Comparison of orbital volumes in enucleated patients with unilateral retinoblastoma: hydroxyapatite implants versus silicone implants. Ophthal Plast Reconstr Surg 2007;23(5):393–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Sadiq SA, Mengher LS, Lowry J, et al. Integrated orbital implants—a comparison of hydroxyapatite and porous polyethylene implants. Orbit 2008;27(1):37–40.PubMedCrossRefGoogle Scholar
  15. 15.
    Long JA, Tann TM 3rd, Bearden WH 3rd, et al. Enucleation: is wrapping the implant necessary for optimal motility? Ophthal Plast Reconstr Surg 2003;19(3):194–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Shields CL, Uysal Y, Marr BP, et al. Experience with the polymer-coated hydroxyapatite implant after enucleation in 126 patients. Ophthalmology 2007;114(2):367–73.PubMedCrossRefGoogle Scholar
  17. 17.
    Smith B, Bosniak SL, Lisman RD. An autogenous kinetic dermis-fat orbital implant: an updated technique. Ophthalmology 1982;89(9):1067–71.PubMedGoogle Scholar
  18. 18.
    Heher KL, Katowitz JA, Low JE. Unilateral dermis-fat graft implantation in the pediatric orbit. Ophthal Plast Reconstr Surg 1998;14(2):81–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Mitchell KT, Hollsten DA, White WL, et al. The autogenous dermis-fat orbital implant in children. J AAPOS 2001;5(6):367–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Peylan-Ramu N, Bin-Nun A, Skleir-Levy M, et al. Orbital growth retardation in retinoblastoma survivors: work in progress. Med Pediatr Oncol 2001;37(5):465–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Foster JA, Castro E, Papay FA. Reconstruction of the irradiated contracted socket with an expanded superficial temporalis fascial flap. Am J Ophthalmol 1999;127(5):621–2.PubMedCrossRefGoogle Scholar
  22. 22.
    Li D, Jie Y, Liu H, et al. Reconstruction of anophthalmic orbits and contracted eye sockets with microvascular radial forearm free flaps. Ophthal Plast Reconstr Surg 2008;24(2):94–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Hykin PG, McCartney AC, Plowman PN, et al. Postenucleation orbital radiotherapy for the treatment of malignant melanoma of the choroid with extrascleral extension. Br J Ophthalmol 1990;74(1):36–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Blanco G. Diagnosis and treatment of orbital invasion in uveal melanoma. Can J Ophthalmol 2004;39(4):388–96.PubMedGoogle Scholar
  25. 25.
    Macfaul PA, Bedford MA. Ocular complications after therapeutic irradiation. Br J Ophthalmol 1970;54(4):237–47.PubMedCrossRefGoogle Scholar
  26. 26.
    Baylis HI, Call NB. Severe enophthalmos following irradiation of the anophthalmic socket: surgical approaches. Ophthalmology 1979;86(9):1647–54.PubMedGoogle Scholar
  27. 27.
    Karesh JW, Putterman AM. Reconstruction of the partially contracted ocular socket or fornix. Arch Ophthalmol 1988;106(4):552–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Bowen Jones EJ, Nunes E. The outcome of oral mucosal grafts to the orbit: a three-and-a-half-year study. Br J Plast Surg 2002;55(2):100–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Moshfeghi DM, Moshfeghi AA, Finger PT. Enucleation. Surv Ophthalmol 2000;44(4):277–301.PubMedCrossRefGoogle Scholar
  30. 30.
    Walter WL. Update on enucleation and evisceration surgery. Ophthal Plast Reconstr Surg 1985;1(4):243–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Nakra T, Simon GJ, Douglas RS, et al. Comparing outcomes of enucleation and evisceration. Ophthalmology 2006;113(12):2270–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Eagle RC Jr, Grossniklaus HE, Syed N, et al. Inadvertent evisceration of eyes containing uveal melanoma. Arch Ophthalmol 2009;127(2):141–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Schefler AC, Abramson DH. Should evisceration ever be done in a blind, painful eye? Arch Ophthalmol 2009;127(2):211–2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Orbital and Ophthalmic Plastic SurgeryUniversitat Autonoma de Barcelona, I.M.O. BarcelonaBarcelonaSpain
  2. 2.Section of Ophthalmology, Department of Head and Neck SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

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