Eye Removal Surgery
Eye removal surgery is done by an ophthalmologist, usually experienced in retinoblastoma care.
If your child has already received treatments, this surgery will likely be done by the ophthalmologist who led the previous care.
Enucleation can be a very confusing and overwhelming process, particularly if your child has just been diagnosed with cancer. Knowing what to expect on the day can help you prepare yourself and your child.
During the Surgery
Your child will receive a general anaesthetic and will not feel anything during the surgery. The surgeon will carefully detach the muscles from the eyeball and cut as long a piece of optic nerve as possible, usually 8-12mm. The eyebrow and eyelids remain intact.
The eye and nerve are removed in one piece and sent to a pathologist to examine. A small sample of tumour tissue may be removed from the eye for genetic testing.
Eye transplants are not possible – a removed eye cannot be replaced with another real eye. An orbital implant is usually placed in the socket to fill space previously occupied by the eye, and tissues surrounding the eye are sewn over it.
Some doctors do not use implants because they believe an implant will mask signs of recurrence. This is not true, and a well trained doctor can differentiate between recurrence and the imaging features of an implant. However, an implant cannot be inserted if cancer already extends significantly outside the eye.
Regardless of whether an implant is used or not, once the socket heals within a few weeks of surgery, it will look pink, like the inside of your lip.
A clear plastic shell called a “conformer” is put into the eye socket, behind the lids, to help the socket keep its shape while healing. This shell may have a hole in it, through which drops are given. Some conformers are painted to look like real eyes.
The surgery usually takes between 45 minutes and 1.5 hours. When cancer has already spread outside the eye, the surgery may take much longer if more extensive portions of the optic nerve and orbital tissues are also removed.
After the Surgery
A pressure patch will be placed over the eye socket to protect the surgery site and reduce tissue swelling, bruising, and risk of infection. The patch will remain in place for several days and will usually be removed in clinic at the follow-up appointment.
The anaesthetist will give a dose of local anaesthetic to control any pain when your child wakes. This usually lasts for the first 24 hours, and residual pain after this time can be managed well with paracetamol.
Children usually recover very rapidly, playing and moving about as normal once the effects of general anaesthetic have faded. Most children lose sight slowly over a long time, and have already adjusted to having no vision in that eye.
In some hospitals, eye removal is an outpatient surgery. Others admit children for up to 7 days, particularly when there are other health concerns or the child lives far from medical care. Your doctor will discuss plans with you before surgery. If you have any concerns, you can ask for your child to be admitted overnight.
The eye will be sent to the pathology department for examination under a microscope. The pathologist will look at several specific parts of the eye to assess your child’s risk for tumour spread outside the eye. Your child may receive additional treatment such as chemotherapy or radiotherapy if the risk is high.