OP10.5 | Enucleation, Evisceration and Exenteration Indications — Summary & Reflection

KEY TAKEAWAYS

Enucleation, Evisceration, Exenteration — Key Points:

• Evisceration: Removes intraocular contents; scleral shell + optic nerve preserved. Indications: blind painful eye (phthisis, endophthalmitis). CONTRAINDICATED if intraocular tumour suspected. Always B-scan before evisceration.
• Enucleation: Removes entire globe (cornea + sclera + contents); optic nerve divided. Indications: intraocular tumour (retinoblastoma Group D/E, choroidal melanoma), blind painful eye where tumour cannot be excluded, prevention of sympathetic ophthalmia (within 10–14 days of penetrating injury), severe globe trauma.
• Exenteration: Removes entire orbital contents including eyelids. Indications: orbital malignancy (SCCa, lacrimal gland adenoid cystic carcinoma, conjunctival melanoma), emergency in mucormycosis with failed antifungals.
• Sympathetic ophthalmia rule: Enucleation within 10–14 days of a blind penetrating injury prevents bilateral granulomatous uveitis in the fellow eye.
• Retinoblastoma rule: Evisceration is ABSOLUTELY CONTRAINDICATED — enucleation only.
• B-scan rule: Always perform before evisceration to exclude an intraocular solid mass.
• Cosmetic rehabilitation: ocular prosthesis (post-evisceration/enucleation) or orbital prosthesis (post-exenteration).

REFLECT

The retinoblastoma child from the hook had a disease that — if enucleation is timely and extraocular spread has not occurred — is curable. Yet errors in procedure choice (evisceration instead of enucleation) or delays in diagnosis have historically led to orbital or metastatic recurrence. Think about your role as a general physician: when a parent brings a child with a white pupil (leukocoria), you may be the first doctor to examine that child. What is your obligation — and how quickly should the referral happen? And for the diabetic with the painful blind eye: did the B-scan actually get done before the anaesthetist was booked for the evisceration? Build these safety checks into your future clinical habits.