Eyeball: enucleation - transpalpebral

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Introduction

  • Removal of globe from Tenon's capsule plus a variable amount of extraocular muscles.
  • Two techniques:
    • Transconjunctival.
    • Transpalpebral.

Uses

  • Removal of a permanently blind eye causing chronic pain or irritation. Indications involve, but are not limited to, intraocular neoplasia    , globe rupture , chronic recurrent uveitis    , microphthalmos and phthisis bulbi    .

Advantages

  • Simple technique for removal of painful eye in most cases, except where pyogenic infection or diffuse neoplasia are present.
  • Transpalpebral - preferable if any external eye infection or neoplasia is present.

Disadvantages

  • Cosmetically may be unsatisfactory but cosmesis is improved by placement of an intraorbital prosthesis.
  • Orbital infection may cause wound breakdown and rejection of prosthesis (if used).
  • Entire diseased tissue may not be resectable, ie orbital neoplasm.
  • Transpalpebral technique is slightly more difficult with slightly increased risk of hemorrhage from the skin.

Requirements

Materials required

Minimum equipment

  • Standard surgical kit .
  • Scissors: dissecting - MayoFig.1 Scissors: dissecting - Mayo
    Curved or straight Mayo scissors   (Fig. 1)  .

Ideal equipment

  • Eye speculum for transconjunctival approach.

Minimum consumables

  • 2/0 polyglactin 910 (Vicryl) or polydioxanone (PDS II).
  • 2/0 non-absorbable suture material .

Ideal consumables

  • Sterile intraorbital silicone prosthesis 40-47 mm diameter.
  • 2/0 polypropylene (Prolene) .
  • Stent bandage.
  • 0 non-absorbable suture material for stent bandage.

Preparation

  • 15 min.

Outcomes

Complications

  • Horse is left with sunken orbit (no prosthesis).
  • Orbital infection with wound breakdown and prosthesis rejection: remove prosthesis, administer local and systemic antibiotics and either partially close or leave to heal by secondary intention.
  • Regrowth/continued growth of orbital neoplasm   →   slowly distending orbit.
  • Blunt trauma to orbit causing prosthesis to rotate and skin to necrose.
  • Cyst formation- usually results from retained conjunctiva or perforation of the third eyelid.

Prognosis

  • Good - very low incidence of complications.

Reasons for treatment failure

  • Wound breakdown.
  • Failure to remove diseased tissue.
  • Rejection of prothesis.
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