Enucleation, Evisceration and Exenteration: Indications and Technique
Last updated: November 2026
Removing an eye is sometimes the best treatment: for a painful blind eye, a tumour or uncontrollable infection. Choosing the right operation and placing a well-sized implant make the difference between a comfortable, natural-looking socket and years of problems.
Three operations
| Operation | What is removed | Main indications |
|---|---|---|
| Enucleation | The whole globe, with a section of optic nerve; muscles reattached to the implant | Intraocular tumours (retinoblastoma, uveal melanoma), blind painful eye where tumour cannot be excluded, severe trauma (and the classic concern about sympathetic ophthalmia) |
| Evisceration | The contents of the globe; sclera (often the cornea too) and muscle attachments left | Painful blind eye, endophthalmitis or panophthalmitis (avoids opening the orbit to infection); better motility and simpler surgery |
| Exenteration | The orbital contents including the globe, often the lids | Orbital malignancy (for example sebaceous carcinoma or melanoma invading the orbit), rhino-orbital mucormycosis, severe orbital infections not responding to treatment |
Never eviscerate an eye that may contain a tumour. Always image (B-scan) a blind eye with opaque media before evisceration. Send all removed tissue for histology.
Enucleation: key steps
- 360° peritomy, separate Tenon's capsule.
- Tag and disinsert the four recti; disinsert the obliques.
- Cut the optic nerve with enucleation scissors or a snare (a long segment for retinoblastoma); haemostasis with pressure.
- Place an orbital implant (usually 18–22 mm) deep in Tenon's space; attach the recti to the implant or its wrap.
- Close Tenon's and conjunctiva in separate layers; insert a conformer; pressure dressing.
Implants
| Implant | Notes |
|---|---|
| Non-porous (PMMA, silicone) | Cheap, low exposure risk, less motility |
| Porous (hydroxyapatite, porous polyethylene) | Fibrovascular ingrowth, better motility, higher exposure risk, costlier |
| Wrapping | Donor sclera, fascia lata or mesh to attach muscles and reduce exposure |
| Dermis-fat graft | For secondary or contracted sockets; grows in children |
Complications and the artificial eye
- Implant exposure and extrusion, socket contraction, post-enucleation socket syndrome (deep upper sulcus, ptosis, enophthalmos), infection, discharge.
- Ocular prosthesis fitted about 6–8 weeks after surgery; custom-made prostheses give the best result.
- Advise safety glasses to protect the remaining eye; check the fellow eye regularly.
Where residents slip
- Eviscerating an eye with opaque media without a B-scan.
- Using too small an implant (sunken socket).
- Not sending the specimen for histology.
Test yourself: flip cards
Related: Sympathetic Ophthalmia: Recognition, Treatment and the Enucleation Question, Ocular Tumours: Eyelid, Conjunctiva, Uvea and Orbit, Endophthalmitis: Types, Organisms and Management.
Key sources
- American Academy of Ophthalmology. BCSC Section 7: Oculofacial Plastic and Orbital Surgery, chapter on the anophthalmic socket (current edition)
- Custer PL, et al. Enucleation and evisceration: Ophthalmic Technology Assessment. Ophthalmology. 2003;110:2042-2056
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