Enucleation – Ocular Melanoma Treatment
Surgical removal of the eye, most often reserved for large tumors or when vision cannot be preserved. A conformer is placed at the time of surgery to maintain the shape of the socket, and a prosthetic eye is usually fitted later. In some cases, especially when the tumor has spread beyond the eye, the entire socket and surrounding tissues may also need to be removed.
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Before Surgery
Decision to Enucleate
- Enucleation is usually considered when:
- The tumor is too large for radiation.
- Vision is already lost or cannot be preserved.
- There is painful glaucoma or tumor recurrence.
- There is concern for extraocular extension (tumor growing outside the eye).
Preoperative Counseling
- You will meet with an ophthalmic oncologist and oculoplastic surgeon.
- The risks, benefits, and emotional impact will be discussed.
- You’ll be fitted for a conformer (temporary implant) and later a custom ocular prosthesis.
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The Procedure
Surgical Steps
- Performed under general anesthesia (you’ll be asleep).
- The entire eyeball is carefully removed.
- Optic nerve is clipped (as close as possible to the globe).
- A ball-shaped orbital implant (usually made of porous material like hydroxyapatite or silicone) is placed in the eye socket to restore volume.
- Muscles that controlled the eye are attached to the implant to allow natural movement.
Post-Op Setup
- A temporary conformer (plastic shell) is inserted to maintain the shape of the socket.
- The eyelids are partially sewn shut (temporary tarsorrhaphy) to protect healing tissue.
- The eye is covered with a pressure patch for 1–2 days.
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Recovery Period
First Few Days
- Mild pain, swelling, bruising around the eyelids.
- Medications include antibiotics and pain relievers.
- The pressure patch is removed within 48 hours; you’ll see swelling and sutures.
Follow-Up Visits
- You’ll be closely monitored for signs of infection or complications.
- Stitches dissolve or are removed after a few weeks.
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Ocular Prosthesis
Fitting the Prosthetic Eye
- About 6–8 weeks post-surgery (after swelling resolves), you’ll be referred to an ocularist.
- They’ll craft a custom-made prosthetic eye that matches your other eye in size and color.
- The prosthesis fits over the implant and under the eyelids.
Movement and Appearance
- Most modern prostheses move in coordination with the remaining eye.
- Many people find the cosmetic result quite natural.
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Risks and Side Effects
Common Short-Term Effects
- Swelling, bruising, mild bleeding.
- Temporary eyelid stiffness or discomfort.
Long-Term Risks
- Implant migration or extrusion (rare with modern materials).
- Socket infection or inflammation.
- Dry eye or discharge.
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Emotional Adjustment
- Losing an eye is a significant psychological event.
- Grief, anxiety, or changes in self-image are common.
- Support groups, counseling, and patient networks like A Cure In Sight can help you cope.
- Many patients return to regular life—including work, driving (if the other eye has good vision), and sports—after recovery.
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Prognosis and Monitoring
- Enucleation often provides excellent local tumor control.
- Your removed eye is sent for histopathologic analysis to evaluate tumor type, size, cell characteristics, and any extrascleral extension.
- Ongoing follow-up includes:
- Orbital exams to check for regrowth.
- Imaging and systemic monitoring for metastatic disease, especially in the liver.