Surgical Eye Removal and Prosthetic Eye Placement

Evisceration, enucleation, and exenteration are advanced ophthalmic surgical procedures performed to remove the eye when the anatomical integrity or physiological function can no longer be preserved, or when the eye itself represents a potential risk to the patient’s systemic or local health. These interventions involve the partial or complete removal of ocular and, in some cases, periocular structures. Although considered definitive and life-altering, these surgeries are often essential in the broader context of ocular rehabilitation and long-term patient wellness.

Each procedure is undertaken with the primary goals of alleviating suffering, preventing further complications, and stabilizing the orbital environment. A critical aspect of these surgeries is the preservation of the surrounding orbital anatomy to the extent possible, ensuring optimal outcomes for subsequent rehabilitation.

Following surgical removal of the eye, the process of ocular prosthetic integration plays a pivotal role in the patient’s recovery. The placement of a custom-fitted ocular prosthesis serves not only to restore facial symmetry and maintain orbital volume but also to enhance emotional resilience and psychological adjustment. This integrated approach to both functional and aesthetic restoration contributes significantly to improving the patient’s quality of life, social interaction, and self-image.

Why Cuba

In Cuba, surgical eye removal procedures such as evisceration, enucleation, and exenteration are performed with a high degree of clinical precision by ophthalmic surgeons who specialize in complex ocular interventions. The nation’s reputation for medical excellence is reflected in its meticulous surgical techniques, which aim to eliminate pathology while preserving the integrity of surrounding orbital structures, thus facilitating optimal prosthetic outcomes.

Recognizing the profound physical and emotional impact of eye loss, Cuban ophthalmology teams conduct thorough preoperative evaluations to assess orbital anatomy, identify the most appropriate surgical approach, and plan for prosthetic integration. Each case is reviewed by a multidisciplinary team to ensure the chosen method aligns with the patient’s medical condition, long-term goals, and quality-of-life considerations.

Cuba offers both traditional and modern surgical techniques depending on the clinical indication, often incorporating biocompatible orbital implants to maintain socket volume and support natural movement of the future ocular prosthesis. The postoperative phase is managed with great care, focusing on pain control, inflammation reduction, and socket health stabilization, all of which are crucial for successful prosthetic fitting.

Conditions and Causes That May Require Surgical Eye Removal

Several medical conditions necessitate removal of the eye or orbital contents to prevent further complications or relieve pain. These include:

• Severe ocular trauma resulting in an irreparably damaged eye
• Painful blind eye due to end-stage glaucoma or chronic inflammation
• Intraocular tumours, such as retinoblastoma or choroidal melanoma
• Orbital malignancies invading surrounding tissues
• Severe infections, such as panophthalmitis or uncontrolled endophthalmitis
• Congenital deformities or disfigured eyes without visual potential
• Phthisis bulbi, a condition where the eye becomes atrophied and non-functional following chronic disease or injury
• Sympathetic ophthalmia, a rare bilateral inflammatory response where the immune system attacks the healthy eye after trauma or surgery to the other eye
• Failed ocular surgeries or complications from implants
• Autoimmune or inflammatory eye diseases causing structural damage
• Thermal or chemical burns causing irreversible damage to intraocular tissues
• Post-radiation complications, particularly in patients who have received ocular or orbital radiation therapy leading to necrosis or pain

Symptoms of Conditions That May Require Eye Removal

The following symptoms may indicate severe ocular conditions in which the preservation of the eye is no longer viable, and surgical removal becomes necessary to protect the patient’s health, relieve pain, or restore quality of life.

Severe Eye Pain Unresponsive to Treatment

• Intense, chronic eye pain that does not improve with medical therapy may indicate irreversible damage or underlying pathology that cannot be resolved without surgical intervention.

Complete Loss of Vision

• A total and irreversible loss of visual function, particularly when accompanied by structural damage, disfigurement, or pain, may necessitate surgical removal of the eye.

Persistent Inflammation or Infection

• Chronic intraocular inflammation or recurrent infections—such as uveitis, panophthalmitis, or endophthalmitis—that are resistant to antibiotics or immunosuppressive therapies can lead to ongoing tissue destruction, pain, and systemic complications, requiring surgical removal to prevent the spread of infection and to safeguard the patient’s overall health.

Visible Eye Deformity or Mass

• The presence of a disfigured, shrunken, or abnormal-looking eye—whether due to trauma, congenital malformation, or tumour growth—can cause significant cosmetic and emotional distress. When the eye no longer serves a visual function and cannot be rehabilitated cosmetically through less invasive means, removal followed by prosthetic replacement offers a more natural appearance and improved facial symmetry.

Proptosis (Eye Bulging)

• Forward displacement of the eye, or proptosis, may occur due to tumours, severe infections, or orbital congestion. In extreme cases where the bulging eye causes exposure keratopathy, optic nerve compression, or pain, and when other treatment options are exhausted, eye removal may be necessary to alleviate symptoms and restore orbital balance.

Bleeding from the Eye

• Spontaneous or trauma-induced hemorrhage within or around the eye that recurs or cannot be controlled may signify serious internal damage, vascular abnormalities, or malignancy. Ongoing bleeding can lead to increased pressure, pain, and secondary complications, sometimes requiring surgical eye removal to control the condition and prevent further harm.

Psychological Distress Due to the Appearance or Function of a Blind Eye

• Living with a visibly damaged, blind, or disfigured eye can significantly affect a person’s self-esteem, mental health, and social interactions. When the emotional burden becomes severe and is not alleviated by non-surgical approaches, surgical removal followed by the placement of a prosthetic eye can offer not only aesthetic rehabilitation but also profound psychological relief and an improved sense of well-being.

Conclusive Pre-Surgical Diagnosis

A thorough diagnostic evaluation is essential before proceeding with surgical eye removal. This process ensures accurate assessment of the underlying condition, surgical planning, and overall patient safety. It typically includes the following:

Comprehensive Ophthalmologic Examination

• A detailed eye exam is performed to assess the anterior and posterior segments, evaluate ocular motility, and detect signs of infection, inflammation, or neoplasia. Evaluation of the extraocular muscles and adnexal structures is also critical in surgical planning.

Ocular Ultrasound to Assess Internal Structures

• When direct visualization is limited due to opacities or trauma, ultrasonography allows imaging of intraocular structures, helping detect retinal detachments, intraocular tumors, hemorrhage, or foreign bodies. A-scan may also be used for axial length measurement, aiding in orbital implant size selection post-removal.

CT or MRI of the Orbits to Evaluate Tumor Extent or Infection

• Cross-sectional imaging provides crucial information about orbital anatomy, tumour invasion, bone involvement, and spread to adjacent structures. MRI is especially valuable in soft tissue assessment and differentiating malignant from benign lesions, while CT is preferred in cases involving trauma or bony deformities.

Biopsy in Suspected Malignant Cases

• When an intraocular or orbital mass is present, a fine-needle aspiration (FNA) or incisional biopsy may be required to confirm the nature of the lesion. Histopathological evaluation guides the surgical approach and the need for additional oncologic or systemic therapy.

Visual Acuity and Visual Field Testing (If Any Vision Remains)

• These tests help establish baseline visual function and determine whether the eye retains any useful vision. I

Systemic Evaluation to Assess Overall Patient Health and Comorbidities

• A full medical work-up is performed to identify conditions that may impact surgical safety or recovery, such as diabetes, cardiovascular disease, bleeding disorders, or immunosuppression. Preoperative blood tests, ECG, and anesthesia clearance are standard. For tumor cases, systemic staging may also be required to detect metastasis or systemic malignancy.

These assessments help determine the most appropriate surgical approach and ensure patient safety.

The Type of Eye Surgical Procedures

Eye removal procedures can be effectively performed using specialized surgical techniques aimed at eliminating the underlying pathology, preserving orbital structure, and preparing the socket for optimal prosthetic eye placement and long-term rehabilitation.

Surgery may be recommended for:

• Patients with a non-functional, painful eye due to trauma or disease
• Individuals diagnosed with intraocular or orbital malignancies
• Patients with chronic ocular infections unresponsive to treatment
• Individuals seeking prosthetic rehabilitation for psychological or cosmetic improvement
• Patients in good general health, able to undergo anesthesia

Surgery may not be recommended for:

• Eyes with preservable vision or reversible conditions
• Patients with untreated systemic infections or unstable medical conditions
• Individuals with psychological or emotional barriers to accepting prosthetic eye placement (unless resolved through counseling)
• Those unwilling to undergo permanent eye removal

Surgical procedures include:

Evisceration

• Performed under general anesthesia
• The cornea is removed, and internal contents are extracted
• A spherical implant is inserted to maintain orbital volume
• The sclera is closed over the implant, and the conjunctiva is sutured
• Allows better prosthetic mobility due to preserved muscle attachments
• Considered less invasive and often associated with faster recovery

Surgery may be recommended for:

Enucleation

• Entire globe (eyeball) is detached from optic nerve and extraocular muscles while preserving orbital tissues and extraocular muscles.
• Indicated for intraocular tumours, severe infections, or trauma.
• An orbital implant is placed, and muscles are sutured to the implant
• The conjunctiva is closed, forming a smooth socket
• Followed by custom prosthetic fitting
• Considered a traditional surgical procedure, but modern techniques minimize trauma and enhance outcomes

Exenteration

• Most extensive procedure: removal of the eye, surrounding tissues, muscles, and sometimes eyelids.
• Followed by reconstructive surgery or facial prosthesis placement
• Used only in extensive orbital tumours or life-threatening infections

Prosthetic Eye Placement

After appropriate healing (typically 6–8 weeks post-surgery), the patient is fitted for a custom ocular prosthesis, designed to:

• Match the natural eye in color and shape
• Restore facial symmetry
• Offer natural movement, especially when muscles are preserved