Treatment of Blind Painful Eye

Quick Facts:
  • The discomfort associated with some blind eyes can be so great as to impair one’s ability to work, sleep, and function.
  • Medical treatment for blind, painful eyes is usually unsuccessful.
  • Surgical treatment of blind, painful eyes is extremely successful in relieving pain while and typically produces highly favorable cosmetic outcomes.
  • Enucleation refers to the removal of the entire eye.
  • Evisceration refers to the removal of the eye’s contents while the white, outer wall of the eye and the muscles controlling eye movement are left intact.
  • An artificial eye is typically fashioned 6 weeks following enucleation or evisceration surgery.

Due to injury, disease, or surgery eyes can sometimes become blind and painful.  The pain can be severe enough that affected individuals are unable to work, sleep, or function normally.  When this occurs, special treatment is required.

Pain from a blind eye is usually not readily controlled without the use of narcotic medications (strong, addictive medications that impair one’s ability to think and function well).  Eye drops and non-narcotic pain relievers such as Tylenol, Advil, and arthritis medicines typically do not provide the necessary relief.  Injections of medication behind the eye have been used in the past but carry an unacceptably high risk of complications.  The best solution to relieve the pain associated with blind, painful eyes is surgery.

There are 2 surgical approaches that may be used to treat blind painful eyes, enucleation and evisceration.  Enucleation refers to the surgical removal of the entire eye while evisceration refers to a procedure in which the contents of the eye are removed while the outer, white part of the eye is left intact.  In enucleation surgery the muscles that control movement of the eye are disinserted and manipulated while in evisceration surgery these muscles are left untouched.  Consequently, movement of the artificial eye may be better after evisceration than enucleation.  In conditions where the eye is being removed to treat a cancerous tumor contained within, enucleation is the only option.  In all other situations, evisceration may represent a more favorable option.

Enucleation_EviserationEnucleation and evisceration procedures are typically performed in an outpatient surgery center.  Most patients choose to be put entirely to sleep (general anesthesia) although local anesthesia may be used in conjunction with sedation (“twilight sleep”) may be used when required due to underlying medical conditions.

At the time of evisceration or enucleation surgery an implant is placed within the eye socket to replace the volume lost when the Enucleation and evisceration procedures are typically performed in an outpatient surgery center.  Most patients choose to be put entirely to sleep (general anesthesia) although local anesthesia may be used in conjunction with sedation (“twilight sleep”) may be used when required due to underlying medical conditions.

At the time of evisceration or enucleation surgery an implant is placed within the eye socket to replace the volume lost when the eye and/or its contents are removed.  The implant is usually a sphere made of artificial or natural materials and is covered by the patient’s own tissue.  If an enucleation is performed, the muscles responsible for the eye’s movement will be attached to the implant.

Approximately 6 weeks after surgery an artificial eye, or prosthesis, is made by an ocularist.  The prosthesis is custom fitted to your eye socket for maximum comfort and movement and the front surface is painted to look like the remaining normal eye.  The prosthesis is easily removable for cleaning.  Occasionally a peg will be placed in the implant to help improve the movement of a prosthesis.  However, peg placement is associated with a higher risk of complications and should be performed only when limitation of prosthetic movement presents a significant cosmetic problem.  This is uncommon.  Enucleation and evisceration are extremely successful in relieving the pain associated with a blind, painful eye.

Patients typically leave the outpatient surgery center approximately 1-2 hours after surgery has been completed.  A large patch is usually placed over the operated eye and this may be removed at home the day after surgery.  A stitch is usually placed between the upper and lower eyelids and is left in place until your first postoperative visit, usually about 1 week after surgery.  Once the stitch is removed, some patients choose to wear a patch until they are fitted with a prosthesis while others do not.

After you have received a finished prosthesis, it is important to follow up with Dr. Biesman on a regular, if infrequent (1-2 times per year) basis.  The eye socket tissues often shrink or deflate over time after enucleation or evisceration surgery adjustment of the eyelids or eye socket volume is often necessary.months or years later.