Enucleation (Removal of the Eye)
Why Might this Procedure be Necessary?
In almost all cases, the eye is removed because it has reached a point where it has no chance of being capable of sight and it is painful. Trauma to the eye (such as an infected scratch or puncture to the eye, hitting the eye on something sharp), tumors of the eye, glaucoma (increased pressure inside the eye), and herpes-related ulcers on the eye (in cats) are all catastrophes. Any of these conditions or others creates a painful, blinded eye. Brachycephalic breeds (those with flattened faces and prominent eyes) tend to be predisposed to eye injuries and often it is these breeds that end up with one eye enucleated. The focus must become the relief of pain when restoring vision becomes hopeless.
Are there any Alternatives to Enucleation?
Most people have a strong preference for their pets to have two eyes and would like to keep both their pet’s eyes if possible. Frequently, this is indeed possible with the help of a board certified ophthalmologist. Many eye wounds can be trimmed and closed with proper magnification and tiny sutures. Sometimes the inner contents of the eye can be removed and replaced with a prosthesis. (This is called evisceration and the prosthesis is called a black ball.) This creates a more natural-looking eye but is not appropriate for infected eyes or eyes with tumors. There are also advanced procedures that can resolve glaucoma surgically and still spare the eye.
All of the above are highly specialized procedures that can only be performed by an ophthalmology specialist. Often enucleation is selected as the other procedures are too expensive (they often cost three or four times as much as enucleation) or enucleation may simply be the best choice.
If you are interested in pursing an advanced procedure, you will need a referral to a board certified ophthalmologist. To locate someone in your area, visit www.acvo.com.
Is the Surgery Painful or Disfiguring?
The Shih Tzu shown at the top of this page is a rescue named Winky for obvious reasons. His picture shows a typical end result of enucleation. In brachycephalic breeds like Winky, most owners let the hair grow long over the enucleated side and the result is not at all objectionable. It is not painful after the initial post-surgical recovery, but during recovery the surgical area is quite sore. Pain management strategies for pets have become quite sophisticated in recent years. Expect some sort of pain relieving medications to be needed during the first week or so after surgery.
What can we Expect after the Surgery?
In surgery, the eye is removed and the eyelids are sewn closed. Sometimes there are stitches to be removed in 10 to 14 days but sometimes the stitches are buried inside the eye socket. The eyelids will be swollen and there may be some bruising. (If the eye injury is more recent, there tends to be more swelling and bruising than if the injury is more chronic.) Some red-tinged fluid may seep from the incision and this is normal. At first the eye may look like it is simply closed. Over the first week following surgery, the swelling will go down and the socket will flatten out. An Elizabethan collar is often provided to discourage rubbing or scratching of the area. This collar should stay in place for 10 to 14 days until the incision is healed. The pet should be able to eat and drink with the collar in place but if you are concerned, you may remove the collar at meal time provided the pet is well supervised.
The pet will have lost peripheral vision on the side of the enucleation and may need to adjust to being approached from this side. Cats should be kept as indoor only pets after an enucleation as the outdoor lifestyle will pose even more hazard than usual.
What Signs Would Indicate a Problem?
Infection may pose a complication. In this event, the eye area would remain swollen after the initial week and the incision may drain pus. If this occurs, the infection would require drainage and antibiotics. If you think there may be an infection, recheck with your vet as soon as possible. Remember, some mild oozing of red-tinged fluid is normal during the first few days after surgery.
If the eye was enucleated due to a severe tear or rupture, the eye may not be removed in one piece. Sometimes a small fragment of the rear eye membranes remains behind. If enough of this tissue is present, secretion of fluid can continue and chronic oozing from the incision can be a problem. If this is excessive, the eye socket may require a second surgery to be fully cleaned out.
What Limitations will the Pet Have?
As long as the other eye is visual, there are not likely to be any serious handicaps. The pet will not be able to see on the enucleation side and may bump into objects there. The pet may be easily startled when approached from that side. Otherwise, once healing is complete, life can return to normal. If your pet has a condition that endangers the remaining eye, be sure you understand any preventive measures that should be taken.
Further questions on this procedure should be directed to your veterinarian or, if you like, go to the homepage of Veterinary Partner for the Ask-A-Vet feature.
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