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Eye Removal - Removal Of The Eye

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					 Patient Information Leaflet




 Removal Of The Eye




       Produced by:
Department of Ophthalmology




        June 2005
 Reviewed September 2008




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Removal of the eye

Your Consultant has suggested that the best form of treatment for your
condition would be removing your eye. We understand this is often a
frightening thought, and hope that this information booklet will help to
answer some of your questions.

What does the operation involve?

An evisceration is the removal of the contents of the eye but leaving
the sclera, (white of the eye), in place. An enucleation removes all of
the eye, including the sclera.

Before a doctor or other health professional examines or treats you,
they need your consent. Sometimes you can simply tell them whether
you agree with their suggestion. However, a written record of your
decision is essential before any surgical treatment. You will be asked to
sign a consent form, after being given full information concerning
success rates and potential risks. If you later change your mind, you’re
entitled to withdraw consent – even after signing, but before the
procedure takes place. In addition to this, please ask the staff looking
after you if you require a sickness certificate.

What will my eye look like after the operation?

Many people are worried about what the eye socket will look like after
the operation. When the eye is removed, we stitch together the
conjunctiva, the layer that normally joins the eyelids and covers the
surface of the white of the eye. This forms a continuous lining inside the
socket. This lining is pink in colour, and looks similar to the inside of
your eyelids. At the end of the operation, your doctor will insert a small
plastic shaper, called a conformer shell, which helps to keep the eye
socket and eyelids in the correct position. This shell should stay in place
until your appointment. Occasionally, the shell may fall out. This is not a
problem as it can be easily be replaced at Eye Outpatients.

About 6-8 weeks after your operation you will be seen by the
Prosthetist, (the artificial eye fitter), who will supply you with a
temporary artificial eye. This eye will be carefully chosen to match your
other eye.

Approximately 3 months after your operation, and once any swelling
has settled down, the prosthetist will make you a custom-made artificial
eye. This will involve taking a mould of your socket, (this does not hurt),
and the process lasts about 15 minutes. Your custom-made eye will
then be ready for you in 2-3 months.


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Some common questions

Will they take the correct eye?

Yes. In many people the eye to be removed will look obviously different
from the good eye and it is therefore clear which eye should be
removed. If the eyes look identical, on the day of your operation we will
mark a cross, with your agreement, above the eye to be removed. If
there is an abnormality inside the eyeball, you may have drops put in
your eye to enlarge the pupil so that the surgeon can examine inside
the eye, just prior to starting surgery and confirm it is the correct eye to
remove. In all patients having an eye removed, there are repeated
checks to confirm the correct eye is to be removed

Is the operation painful?

The operation can be carried out under general or local anaesthetic.
You will not feel anything during the operation. Any pain in the early
days after the operation can be relieved with painkillers.

How long will I be in hospital?

Generally 1-2 days, but this varies and depends on how well you feel
and what help or support you need.

Will this be the end of my eye problem?

This depends on the reason for removing your eye. You may have
some pain in and around the socket for a few days or weeks after the
operation. Very rarely, people have the sensation of pain or vision in the
removed eye socket area for some time after the operation. However,
virtually every patient who has an eye removed because of pain, ends
up pain-free.

Is an implant the same as an artificial eye?

No. An implant is the filler, or packing, we put into the socket during the
operation to maintain the volume in the socket and cannot be seen. An
artificial eye is like an enlarged contact lens made to look like the other
eye.

How long before I can have an artificial eye?

After 6-8 weeks you can be fitted with a temporary eye, before a
custom-made eye can be made for you at 3 months.



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Will I be able to see again?

Not with that eye. An artificial eye is a cosmetic shell and has no
function other than to make your appearance as normal as possible.

Will the artificial eye match my good eye?

The prosthetist will aim to make the best possible match to your other
eye when they create your artificial eye. The prosthetist will explain all
of this to you at your appointment with him/her.

Will it be noticeable to other people?

Once you have an artificial eye in place, it will not be noticed by most
people. Some people might notice that the artificial eye may not move
as much as the other eye. Of course, if your eye has been obviously
different to the other eye, before the operation people may comment
that the eye looks different, or even better.

Will the artificial eye move?
All artificial eyes move to some extent. How much they move is
somewhat dependent on the type of operation we perform. In an
evisceration, the muscles that normally move the eye remain attached
in their usual places and this often gives greater movement to the
artificial eye. In most cases you will have an implant inserted into the
socket or white of the eye during your operation. This is done so that
some of the space made when the eye is removed is replaced in the
socket. In some patients, this implant can be connected to the back of
the artificial eye to further improve movement at a later date.

How do I care for the artificial eye?

You will need to learn to remove and replace the artificial eye so that
you can keep it clean. The prosthetist will teach you how to do this.
Other than this, it is generally not necessary to remove the eye.

Will it be painful to remove the artificial eye?

No. Removing the artificial eye should not cause any discomfort.




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Will the artificial eye fall out?

No. In general, your artificial eye will not fall out, although it may
become dislodged if you dive into a pool or receive a hard blow to the
head.

What happens if I cry?

The tear glands are not affected by the operation, and you will cry
normally.

Will I still be able to blink normally?

The operation will not affect the muscles controlling your eyelids.

Can I still drive after I have my eye removed?

If the eye you had removed had no useful vision for some time before
the operation, and you were able to drive then, you will be able to
continue driving almost immediately. If your eye had useful vision, then
you may need a period of adjustment before you can drive. Also, your
other eye needs to have appropriate vision for driving. It is advisable to
inform your insurance company of any changes of health.

Does having an artificial eye stop me from swimming or playing
sport?

Once the socket has healed there is no reason why you cannot swim or
play sport.

What are the complications of this operation?

•     Short term
You may get some pain in and around the socket and you may find that
you have problems judging distance if your eye had useful vision before
the operation. There is also a small risk that you may get an infection in
the socket so we may give you antibiotic drops and/or tablets to prevent
this.

•     Long term
The socket may change shape and the artificial eye need replacing to
accommodate this. The eye lids may become lax over time due to the
weight of the artificial eye, and then you may want to ask your doctor
about surgery to correct this. Some people find they develop a slight
allergy to the artificial eye. However, this can be treated with anti-allergy
eye drops. In rare cases, the implant may work its way out through the


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lining tissue and need removal to prevent it from becoming infected.
This is called extrusion. As mentioned earlier a few people do have
phantom vision or pain from the removed eye for some time after the
operation.

If you have any queries related to this topic, or seek advice, please
contact the Staff Nurses at the Eye Clinic, 9am-5pm, Mon-Fri, 534504.

You can find more information on all sorts of health issues through NHS
interactive available through Sky TV or online at: http://www.nhsdirect.nhs.uk/

For Health advice and out of hours GP service please call Island Health Care
on 0845 6031007

We Value Your Views On Our Service

If you wish to comment on the care which you, your relative or friend has
received, we will be pleased to hear from you. Please speak to the person in
charge of the ward, clinic or service in the first instance or ask them to contact
the Patient Advice and Liaison Service. If you wish to contact them directly,
telephone on 524081, extension 4850. Alternatively you may prefer to write to:

Chief Executive
Isle of Wight NHS Primary Care Trust
St Mary’s Hospital
Newport
Isle of Wight

St Mary’s Hospital is a smoke free area.
If you would like help and advice to stop smoking please call:
01983 814280 or 07919 598549

Ref:OPTH/RE/3




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