Definition

• Removal of the entire contents of the eye within the scleral shell.

Discussion

• The sclera and muscles attached to the sclera remain intact to accommodate prosthesis.
• An indication for evisceration is a hopelessly traumatized eye in a young person with no history of previous eye disease.
• The cosmetic result is superior to the result of enucleation because the extrocular muscles remain attached to the scleral shell, resulting in a moveable implant very similar to that of natural eye movement.

Positioning

• Supine position, slightly elevated or flat.
• Arms are tucked and with soft restraints.

Drapes/ Packs

• Ophthalmic packs
• Special eye fenestrated sheet
• Basic pack
• Head or neck pack

Instrumentation

• Basic eye procedure tray
• Globe/ orbit prosthesis tray
• Curettes

Supplies/ Equipment

• Basin set
• Balanced saline solution
• Disposable cautery
• Ophthalmic sponges
• Suction tubing
• Antibiotic ophthalmic ointment
• Blade
• Sphere prosthesis and conformer

Procedure

1. A periotomy is made superiorly from the 3 o’ clock to the 9 o’clock position.
2. An incision (same length) is made in the exposed sclera through to the uvea.
3. The entire uvea is separated from the sclera by an evisceration spoon and is completely removed.
4. The remaining uvea may be removed with a gauze sponge on a hemostat rotated within the scleral shell or with a special curetite.
5. The wound is irrigated and hemostasis is achieved.
6. The scleral edges are held open by tagged sutures while the implant is inserted with a sphere introducer.
7. The posterior surface of the cornea is removed to reduce sensitivity, and the sclera is closed with interrupted sutures.
8. The conjunctiva is approximated.
9. A comformer is placed in the cul-de-sac.
10. Antibiotic ointment is instilled and an eye pad and metal shield are applied.

Perioperative Nursing Consideration

1. Have the prosthesis ready to implant.
2. Follow hospital protocol regarding documentation of the prosthesis, and complete the enclosed manufacturer’s form.
3. Strict aseptic technique during the entire procedure.
4. Educate the patient about the changes and adjustment necessary after the procedure.