Enucleation
What is Enucleation ?
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Why do you need Enucleation ?
Enucleation is indicated for:
- Ocular malignancies:
- Retinoblastoma: Primary treatment in advanced cases (esp. unilateral, non-responsive to therapy) to prevent spread; common in children <5 years.
- Uveal melanoma: In adults, for large tumors not amenable to radiation or local resection.
- Other cancers: Intraocular lymphoma or metastatic tumors (rare).
- Severe trauma:
- Irreparable globe rupture: When the eye cannot be salvaged after injury (e.g., penetrating trauma).
- Painful blind eye:
- End-stage glaucoma: Uncontrolled pain and pressure in a non-seeing eye.
- Phthisis bulbi: Shrunken, non-functional eye causing chronic pain.
- Severe infection: Endophthalmitis unresponsive to antibiotics, risking orbital spread.
- Cosmetic or prophylactic:
- Disfigured, non-functional eye: Improves appearance and comfort.
- Sympathetic ophthalmia risk: Rare autoimmune reaction post-trauma/infection in one eye, threatening the other eye’s vision.
The procedure aims to remove the diseased or damaged eye, alleviate pain, prevent disease spread (e.g., cancer), and prepare the socket for a prosthesis to restore appearance.
Why Do Enucleation Costs Vary in Philippines?
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Enucleation Procedure
- Before Surgery Evaluation:
- Diagnosis:
- Slit-lamp exam: Assesses the eye’s condition (e.g., tumor, infection).
- Imaging: Ultrasound, CT, or MRI to evaluate tumor size, orbital involvement, or optic nerve extension (e.g., retinoblastoma).
- Visual acuity: Confirms no functional vision in the affected eye.
- Blood tests: Blood sugar, clotting profile, and infection screening (e.g., hepatitis, HIV).
- Medications: Stop blood thinners (e.g., aspirin) 5–7 days prior if safe; antibiotics (e.g., cefazolin) pre-surgery.
- Consent: Risks, including cosmetic outcomes, are explained; psychological counseling may be offered.
- Diagnosis:
- Surgical Techniques:
- Enucleation:
- Performed under general anesthesia, lasting 1–2 hours.
- The conjunctiva (thin membrane over the eye) is incised and reflected.
- Extraocular muscles are detached from the globe (may be sutured to the implant later for movement).
- The optic nerve is cut, and the eyeball is removed.
- An orbital implant (e.g., silicone, hydroxyapatite, or porous polyethylene) is placed in the socket to replace the volume of the eye and support a prosthesis.
- Extraocular muscles are attached to the implant to allow movement.
- The conjunctiva is sutured over the implant with absorbable sutures.
- A conformer (temporary plastic shell) is placed to maintain the socket shape until a prosthesis is fitted.
- Variations:
- In cancer cases: Extra care to avoid tumor spillage; optic nerve stump length maximized for pathology (e.g., retinoblastoma).
- In infection cases: Antibiotics (IV or local) to prevent orbital spread.
- Intraoperative Tools:
- Orbital implant: Replaces eye volume.
- Conformer: Maintains socket shape post-surgery.
- Operating microscope: Enhances precision.
- Enucleation:
- After Surgery:
- Hospital stay: 1–2 days.
- Pain management: IV analgesics (e.g., morphine) for 1 day, then oral (e.g., ibuprofen) for 3–5 days.
- Antibiotics: IV/oral for 5–7 days to prevent infection.
- Eye care: Antibiotic/steroid ointment (e.g., tobramycin-dexamethasone) for 2–4 weeks; eye patch for 1–2 weeks.
- Prosthesis fitting: Custom ocular prosthesis (artificial eye) fitted 6–8 weeks post-surgery.
- Instructions: Avoid heavy lifting or strenuous activity for 4–6 weeks.
Recovery After Enucleation
- Hospital Stay: 1–2 days.
- Post-Surgery Care:
- Pain: Moderate pain for 3–5 days, managed with analgesics; socket discomfort may persist for 1–2 weeks.
- Swelling/Bruising: Around the orbit for 1–2 weeks; cold compresses help.
- Eye care: Antibiotic/steroid ointment 2–3 times daily for 2–4 weeks; keep the socket clean with saline wipes.
- Activity: Avoid heavy lifting or strenuous activity for 4–6 weeks; normal activities (e.g., reading) in 1–2 weeks.
- Socket care: Conformer stays in place until prosthesis fitting (6–8 weeks); avoid removing it unless instructed.
- Prosthesis: Custom-fitted at 6–8 weeks; provides cosmetic restoration and some movement (if muscles attached to implant).
- Follow-Up:
- Visits at 1 week, 1 month, and 6–8 weeks (for prosthesis fitting).
- Oncology referral (if cancer): For adjuvant therapy (e.g., chemotherapy for retinoblastoma).
- Pathology report: Within 5–7 days (confirms tumor margins, optic nerve involvement).
Most resume normal activities in 2–4 weeks; full socket healing takes 6–8 weeks. Cosmetic outcome: 90–95% achieve a natural appearance with a prosthesis; movement varies based on implant/muscle attachment.
Risks and Complications
- Surgical Risks:
- Bleeding (2–5%): Orbital hematoma; may need drainage if severe.
- Infection (2–5%): Socket or orbital infection; treated with antibiotics, may lead to implant extrusion.
- Implant extrusion (1–3%): Implant rejection or exposure; requires removal or replacement.
- Post-Surgery:
- Socket discharge (5–10%): Normal for 1–2 weeks; persistent discharge may indicate infection or implant issues.
- Conjunctival dehiscence (2–5%): Suture line opens; may need resuturing.
- Orbital cellulitis (<1%): Rare; severe infection requiring IV antibiotics or implant removal.
- Long-Term:
- Socket contracture (2–5%): Shrinkage of socket; may complicate prosthesis fitting; requires socket reconstruction.
- Prosthesis issues (5–10%): Poor fit, irritation, or discharge; may need refitting or polishing.
- Phantom eye pain (1–3%): Sensation of pain in the removed eye; managed with medication or counseling.
- Emotional impact: 10–20% experience grief or adjustment issues; counseling helps.
Report severe pain, swelling, fever, or excessive discharge promptly.
Frequently Asked Questions (FAQs)
What causes the need for enucleation?
Ocular cancers (e.g., retinoblastoma, melanoma), severe trauma, painful blind eyes (e.g., glaucoma, phthisis bulbi), or uncontrolled infections.
Can I avoid enucleation?
Yes, if alternatives exist: Radiation or chemotherapy for cancer (e.g., retinoblastoma), evisceration (removes eye contents, leaves sclera), or pain management for blind eyes.
Is enucleation painful?
No, performed under anesthesia; moderate pain post-surgery for 3–5 days, managed with medication.
How soon can I resume activities?
Light activities in 1–2 weeks; normal routines in 2–4 weeks; full recovery in 6–8 weeks.
Is enucleation covered by insurance in India?
Yes, for medical necessity (e.g., cancer, trauma); confirm with your provider.
Signs of complications?
Severe pain, swelling, fever, or excessive discharge.
Will I look normal after enucleation?
Yes, 90–95% achieve a natural appearance with a prosthesis; movement may be limited but often satisfactory.
Lifestyle changes post-surgery?
Avoid heavy lifting for 4–6 weeks, maintain socket hygiene, wear the prosthesis as instructed, attend follow-ups, and seek counseling if needed.
Conclusion
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Looking for Best Hospitals for Enucleation
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.