Primary Surgeries: Enucleation / Resection

Enucleation refers to full removal of the affected eye. Enucleation is indicated for eyes with large tumors, diffuse iris melanomas, eyes with poor initial visual acuity, and those with recurrent tumor.

If you and your doctor choose to remove the eye, you will be admitted to the hospital and your eye will removed under either local or general anesthesia. The enucleated eye cannot be treated or repaired and replaced in the eye socket. Instead, it is replaced with a ball implant that may be made of plastic, a porous material called hydroxylapatite, or other materials. The implant is sewn into position and the eye is allowed to heal.

The patient usually leaves the hospital one or two days after surgery. In some cases, patients are permitted to go home the same day. Three to six weeks later, a specialist who makes artificial eyes (called an ocularist) fits the patient with a prosthesis. The prosthesis is a plastic shell painted to resemble the other eye and inserted between the eyelids. When the other eye moves, the ball implant moves also, causing the prosthesis to move with the normal eye. Movement is usually less than that of the normal eye; however, the doctor and close relatives are most often the only people to notice that the patient does not have two normal eyes. If you have questions about different types of implants, be sure to ask your doctor. The purpose of the implant is to replace the volume in the socket that had been taken up by the eye. (http://www.jhu.edu/wctb/coms/booklet/book2.htm)  OMF also offers financial assistance for certain patients to get ocular implants.

> Dr. Finger's overview of Enucleation

After treatment of your primary tumor, patients will likely experience fatigue for a few weeks. Normal diet may be resumed after discharge from the hospital, unless directed otherwise by your doctor.

Skin Care Around the Eye

• Wash the eye lids with mild soap and lukewarm water and gently pat dry.
• Avoid extreme temperatures (e.g. hot showers, hot water bottles, heating pads, or ice bags) on the affected area.
• Avoid any friction or eyelid rubbing or scratching.
• Radiation blepharitis (eyelid inflammation) can be treated with silvadine ointment, black tea soaks, or A&D ointment.

If not already working with one, patients are strongly encouraged to consult with an oncologist to construct a proper surveillance schedule for ongoing observation and care.

Surgical resection (partial removal) was developed with the intent to save the eye, conserve as much useful vision as possible, and avoiding long-term complications of different methods of radiotherapy and cosmetic disfigurement associated with enucleation. Although radiotherapy is the most commonly used method today in the treatment of choroidal melanoma in most centers, surgical resection may be the treatment of choice in selected patients and can be used alone or with adjuvant radiotherapy decreasing rate of local recurrence. (Learn more about the science here)

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