Enucleation, evisceration and the artificial eye
- Topic
A blind, painful eye or an eye with a tumour can be removed. An orbital implant and a custom-made artificial eye restore volume, movement and appearance.
See it in 3D: Eye fascia · Optic nerve · Eyelids
What it is
Enucleation removes the whole globe and cuts the optic nerve; it is the operation for intraocular tumours such as retinoblastoma and uveal melanoma. Evisceration removes the contents of the eye and keeps the sclera and muscles; it is quicker, gives better movement and is used for blind, painful eyes and severe endophthalmitis, but never when a tumour is possible. In both, an orbital implant replaces volume, a clear shell (conformer) holds the space, and a custom acrylic artificial eye is fitted once the swelling settles.
Key facts
- Indications: intraocular tumour (enucleation), blind painful eye, endophthalmitis that does not respond, a globe destroyed by trauma, and a shrunken eye (phthisis) for appearance.
- Before evisceration in an eye with no view of the fundus, ultrasound or imaging excludes a hidden tumour.
- Implants are porous (tissue grows into them) or non-porous; the muscles are attached to them to give movement.
- The prosthesis is fitted several weeks after surgery by an ocularist and polished and refitted over the years.
- Late problems: implant exposure or extrusion, discharge, a contracted socket, lid laxity or droop, and a sunken upper lid (post-enucleation socket syndrome).
- In young children, the orbit needs the stimulus of an implant and enlarging conformers to grow symmetrically.
In clinical practice
- Sympathetic ophthalmia is a rare bilateral granulomatous uveitis after injury or surgery of one eye; light sensitivity or blurred vision in the remaining eye is urgent.
- Chronic discharge is usually mucus from an ageing or ill-fitting prosthesis or poor hygiene, but a visible implant means exposure.
- One-eyed patients should wear polycarbonate safety glasses to protect the remaining eye.
Next step / Initial management
- Blind, painful eye: refer to ophthalmology to discuss options (drops, cyclodestruction, retrobulbar injection, evisceration or enucleation).
- Before any removal with no view of the fundus: imaging to exclude an intraocular tumour.
- Socket discharge: check hygiene and prosthesis fit; refer if it persists, is bloody or the implant is visible.
- Pain, swelling or an exposed implant in the socket: refer soon (infection or extrusion).
- Red eye, light sensitivity or reduced vision in the remaining eye: same-day ophthalmology (sympathetic ophthalmia).
Test yourself
Think of the answer, then tap the question to see it.
Which operation is used to remove an eye with a uveal melanoma, enucleation or evisceration?
Enucleation, which removes the whole globe; evisceration could leave tumour behind.
What must be done before eviscerating a blind eye with no view of the fundus?
Ultrasound or other imaging to exclude an intraocular tumour.
Weeks after an eye injury, the other eye becomes red and blurred. What must be suspected?
Sympathetic ophthalmia; same-day ophthalmology.
Connections
See it in 3D3
The structures of Durgical's 3D anatomy where it is found.
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Anophthalmic Socket (StatPearls Publishing (NCBI Bookshelf), 2024); Enucleation (StatPearls Publishing (NCBI Bookshelf), 2023); Evisceration (EyeWiki (American Academy of Ophthalmology), 2025).
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Representative model, for educational purposes only.