What is an orbital exenteration?
An orbital exenteration refers to the surgical removal of the eyeball and the surrounding tissues, these including the eyelids (the extent depending on the disease being treated), and the muscles, nerves and fatty tissue adjacent to the eye.
When is an orbital exenteration necessary?
An orbital exenteration is a major operation which is usually undertaken to remove a malignant tumour which involves the eyelids or structures around or behind the eye, and which needs to be removed to prevent local extension and / or spread via the blood stream to other organs (metastatic spread).
The reason for undertaking such extensive surgery is that all other options, in which the eyeball is left intact with the hope of retaining vision, do not offer the best chance of completely removing the tumour, and may thus compromise the overall outlook (prognosis) for life.
Who else can I talk to about this surgery?
Your oculoplastic specialist consultant is always available to discuss any queries as they arise. In addition, patients can be put in contact with skilled and experienced nurse counsellors and ocularists in specialist eye hospital whose roles aer specifically to help patients to cope with the wider psychological aspects of this surgery.
What does this surgery involve?
An orbital exenteration usually takes between approximately an hour, and is usually performed under general anaesthesia although it can be undertaken under deep sedation for older patients who are medically unfit. The eyeball, muscles and fatty tissue surrounding the eye, and part of the eyelids, are all removed. The socket is usually reconstructed with the use of a split thickness skin graft taken from the thigh. Regular postoperative analgesia is prescribed, and most patients are able to go home the following day. On review in clinic a week later, the dressing and superficial skin stitches are removed.
What should I do after surgery?
Patients are advised to clean the skin surrounding the incision using with cool, boiled water; the rest of the face can be washed normally. Because the socket lies alongside the air sinuses, patients should not blow their nose and limit forceful sneezing for 6 weeks after surgery. This will reduce the risk of air entry into the socket and secondary infection. Finally, bruising and swelling tend to settle more quickly by sleeping with the head elevated on extra pillows or two for two weeks.
What happens after surgery?
Full recovery takes many months. With healing, the socket will look more hollowed, and the surrounding skin will feel tighter. In order to improve the aesthetic appearance, an ocular prosthesis, created from silicone and mirroring the fellow eye, is created. This is either fixed to a pair of glasses, or can be attached to the socket using specialised magnetic implants. These prostheses are carefully crafted by a specialist and typically result in a very acceptable aesthetic appearance.
All patients need regular clinical review – for up to 5 years – and in addition may require adjunctive local radiotherapy (once the socket has settled) and / or chemotherapy. This is thought to ‘mop up’ any residual tumour cells should they be present, and is organised by an oncologist with experience in the field.
Am I allowed to drive after exenteration surgery?
For private car or motorcycle drivers, if vision is normal in the other eye and there are no other medical conditions, the DVLA does not need to be informed:
From the DVLA website:
“Monocularity and driving: Monocularity is a condition that you may need to tell the Driver and Vehicle Licensing Agency (DVLA) about. Car or motorcycle driving licence holders: If you are a car or motorcycle driving licence holder – you will not need to tell DVLA about your medical condition.”
If you have any doubt about your fitness to drive, please contact the DVLA, using the following link: