Key Information
What Is an Artificial or Prosthetic Eye?
Artificial eyes, otherwise known as an ocular prosthetics, are non-functional replacements for eyes removed due to eye trauma, disease, or some other cause. They don’t restore the patient’s vision in any way but instead provide cosmetic benefits, resembling a natural, regular (but non-functional) eye, to restore the patient’s self-confidence and quality of life.
A prosthetic eye is designed with great care. It is custom-made, an artificial but accurate copy of the other, working eye, with the same colouration and size. This makes high-quality eye implants almost impossible to discern from the real thing.
When Is a Prosthetic Eye Necessary?
Prosthetic eyes are necessary when the existing eye is damaged or diseased, has lost its ability to see, or is causing its owner pain and discomfort. This can occur because of various eye diseases—like eye cancer or final-stage glaucoma—or because of injuries to the eye that have damaged it beyond the possibility of repair.
In other words, when it’s impossible to save an eye, eye removal surgery and prosthetic eye insertion are usually the best options. The surgery frees the patient from pain caused by their existing eye while also helping them regain a more natural appearance and restoring facial symmetry, which can subsequently aid in terms of self-confidence and body image.
Eye Removal Surgery – Evisceration and Enucleation
Before any prosthetic eyes can be inserted, eye removal surgery is usually necessary. This, as the name suggests, involves taking out the existing eye. It is needed when there is too much damage to the existing eye for it to be repaired via surgical or other means. In other words, it is effectively a “last resort” option and takes two distinct forms – enucleation and evisceration eye surgery.
Enucleation and evisceration are two procedures commonly used in eye surgery. This article will explore both in greater detail.
Before the Procedure
Given the importance of eye removal and prosthetic eye surgery, it is not entered lightly or rushed. As such, all potential surgeries begin at the consultation stage – patients will have chances to speak with their oculoplastic surgeon and undergo evaluations to determine that eye removal and prosthetic eye surgery are the best and most logical steps for them.
What Is the Evisceration of the Eye?
The evisceration procedure is one of the two types of eye removal surgery. It involves removing the eye’s contents but leaving its exterior scleral shell in place. The new eyeball implant will then be placed within that shell – your prosthetic eye will sit on top of that but is not fitted until much later.
During the evisceration of the eye, the optic nerve and muscles connecting to the eyeball are left intact. The contents of the scleral shell – cornea, iris, and retina – are removed, and a temporary implant and conformer are fitted to ensure the eye and eyelids maintain their shape. All this is done under either general anaesthetic.
Since it does not involve as many steps as enucleation, evisceration is the fastest and least invasive of the two forms of eye removal, taking about an hour. It is favoured when the sclera, optic nerve, and muscles are all reasonably healthy or unaffected by trauma or disease, so they do not necessarily need removing.
What Is the Enucleation of the Eye?
Enucleation is when the whole eye—including the scleral shell—is removed, and the connecting muscles and optic nerve are all cut. A ball-shaped implant is then put where the shell once was to preserve the structure and shape of the eye. Muscles are attached to that ball so the patient can still have some movement and control. This is done under general anaesthetic.
As for why it is done instead of evisceration, this method is usually the preferred option in situations involving eye cancer, serious infections, or bad trauma affecting the whole eyeball and surrounding structures, like the optic nerve. It can take up to two hours.
Aftercare – What Is the Recovery Process Like?
It is important to be ready for a relatively lengthy aftercare process after prosthetic eye surgery. This is a significant and impactful procedure that can lead to some side effects.
When the surgery ends, the surgeon will apply a dressing to cover the area, which should be removed about 24 hours post-operation. The transparent shell fitted during surgery will be visible. This shell has a hole in the middle to assist with drainage and airflow and to allow medications to be administered. You must keep this in your eye socket until it has healed and can tolerate a custom eye being fitted.
The area around the eye and the eyelids may exhibit redness, swelling, bruising, and sensitivity, which will gradually improve over time, with the redness fading to pink. It is normal to experience pain and soreness in the eye for a few days, as well as headaches, which can be treated with painkillers. Nausea is another possible side effect.
You will also likely be prescribed eye drops, ointment, or both to apply several times a day to clean the eye and minimise the risks of infection. Antibiotic treatment and pain medication may also be prescribed. It is best to keep the eye uncovered as much as possible to encourage airflow and healing, though wearing dark glasses occasionally for comfort is acceptable.
Finally, your specialist will schedule a follow-up appointment to assess how the eye is healing and discuss the next steps in the process.
How Is a Prosthetic Eye Fitted?
Once your eye has healed sufficiently from the removal – around six weeks, on average – you can start preparing for prosthetic eye surgery.
This process starts with the creation of the artificial eye. A specialist will prepare a mould of your eye socket to ensure the final implant fits just right. They will also have pictures of your other eye to reference to ensure the shape and colours match.
The procedure itself involves removing the conformer that keeps your eyelids propped open in the correct position. The custom prosthetic eye is then slotted into place behind the eyelid. The whole process is painless and takes up to two hours.
It is important to note that this is not a one-off process. Eye sockets change shape with age and time, so you might need readjustments, refittings, or even a new prosthetic made to replace your old one every so often. Indeed, patients usually require replacements every five years. Prosthetic eyes also demand annual cleaning – your specialist can guide you through how to do this yourself.
Other things to note include that pupils on prosthetic eyes can not dilate like natural ones. This can lead to a slight visual inconsistency when people look at you or in photographs, as the pupils of your eyes may not match 100%. Despite this, modern artificial eyes are still remarkably lifelike and hard to tell apart from real ones.
Once your prosthetic eye is in place, you can continue living generally. You can apply makeup around it, go swimming (though it is best to wear goggles for protection), play sports, and so on. Just remember to wear eye protection when doing intense activities that could risk injuries to the eye or possible impacts that might knock the prosthetic out of position.
FAQ
How will the artificial eye look?
Artificial eyes can be very realistic but they will never have the same movement as a normal eye. Your surgeon will attach the eye muscles to the ball implant so there will be some movement but it will not be full. There is also a degree of mucous discharge which is to be expected. This varies from patient to patient but may require daily cleaning of the artificial eye.
What are the risks and side effects of eye removal surgery?
As with any surgery, there are risks of infection, the need for additional surgeries if the first one isn’t carried out correctly, bleeding, and a chance of eyelid drooping, though this is very rare. Common side effects include pain, swelling, and redness in the affected area for a few days post-op.
What kind of anaesthesia is used?
General anaesthesia is most commonly used for eye removal. None is required for actually fitting the artificial eye itself.
How long does the surgery take?
Between one and two hours. Evisceration is a quicker operation than an enucleation.
Can an eyeball be removed and put back in?
No. Eye removal is an irreversible process and is only considered a last resort when eyes are damaged or diseased beyond a reasonable chance of repair.