Evisceration: When is it a necessity? Being the text of a presentation delivered by Dr B.A. Adewara at the Oculoplasty symposium of the 49th Annual Scientific Conference of the Ophthalmological Society of Nigeria on 27th August 2025

Bolajoko A. Adewara; Ritesh Verma

Authors

Bolajoko A. Adewara Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Nigeria https://orcid.org/0000-0002-1127-5638
Ritesh Verma Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Abstract

Introduction: Evisceration is the removal of intraocular contents while preserving the scleral shell and attachments, enabling a more natural coupling between the orbital implant and prosthesis. As the balance between necessity and preference shifts, it is essential to identify when evisceration is the appropriate procedure to prevent unnecessary tissue removal. This review examines evisceration in contemporary practice, with emphasis on when it becomes a necessity rather than a choice.

Methods: A structured narrative review of the literature on indications, contraindications, surgical techniques, orbital implants, complications, and postoperative rehabilitation regarding evisceration was conducted, searching PubMed, Scopus, and Google Scholar from database inception to 31 May 2025.

Findings: Evisceration is primarily indicated or necessary in eyes that are irreversibly blind and painful due to chronic disease or infection. The potential for residual infection within the scleral envelope, the theoretical risk of occult intraocular malignancy, severe scleral thinning, or rupture extending posteriorly may preclude evisceration in selected cases. Factors such as the underlying pathology, the patient's systemic condition, and the desired aesthetic outcome play an integral role in decision-making. The introduction of the scleral wall modifications has enhanced implant sizing, orbital volume restoration, and symmetry. Thus, establishing evisceration as a reconstructive operation capable of achieving good cosmetic and functional outcomes in severely traumatised, phthisical, or anterior staphylomatous eyes.

Conclusion: Evisceration is not only a less invasive alternative to enucleation, but also a reconstructive procedure with specific indications. Careful case selection, ethical counselling, optimal surgical technique, and postoperative rehabilitation remain central to successful patient outcomes.

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References

1. Beer J. Lehre der Augenkrankheiten. Vienna; Heubner and Volke; 1817.

2. Burch FE. Evisceration of the Globe with Scleral Implant and Preservation of the Cornea. Trans Am Ophthalmol Soc. 1939;37:272-282.

3. Levine MR, Pou CR, Lash RH. The 1998 Wendell Hughes Lecture. Evisceration: is sympathetic ophthalmia a concern in the new millennium? Ophthalmic Plast Reconstr Surg. 1999;15(1):4-8.

4. Mules PH. Evisceration of the Eye, and its Relation to the Bacterial Theory of the Origin of Sympathetic Disease. Br Med J. 1886;1(1310):246-247.

5. Mules PH. Evisceration of the globe with artificial vitreous. 1884-1895. Adv Ophthalmic Plast Reconstr Surg. 1990;8:69-72.

6. Ventura-Abreu N, Cifuentes-Canorea P, Ibañez-Flores N. A brief history of the anophthalmic socket surgical technique and orbital implants. Arch Soc Esp Oftalmol (Engl Ed). 2018;93(8):e51-e52.

7. Yousuf SJ, Jones LS, Kidwell ED Jr. Enucleation and evisceration: 20 years of experience. Orbit. 2012;31(4):211-215.

8. Liu D. Evisceration techniques and implant extrusion rates: A retrospective review of two series and a survey of ASOPRS surgeons. Ophthalmic Plast Reconstr Surg. 2007;23(1):16-21.

9. du Toit N, Motala MI, Richards J, Murray AD, Maitra S. The risk of sympathetic ophthalmia following evisceration for penetrating eye injuries at Groote Schuur Hospital. Br J Ophthalmol. 2008;92(1):61-63.

10. Griepentrog GJ, Lucarelli MJ, Albert DM, Nork TM. Sympathetic ophthalmia following evisceration: a rare case. Ophthalmic Plast Reconstr Surg. 2005;21(4):316-318.

11. Goiato MC, Haddad MF, dos Santos DM, Pesqueira AA, Ribeiro Pdo P, Moreno A. Orbital implants insertion to improve ocular prostheses motility. J Craniofac Surg. 2010;21(3):870-875.

12. Jordan DR, Gilberg S, Bawazeer A. Coralline hydroxyapatite orbital implant (bio-eye): experience with 158 patients. Ophthalmic Plast Reconstr Surg. 2004;20(1):69-74.

13. Tripathy D, Rath S. Evisceration with Primary Orbital Implant in Fulminant Endophthalmitis/Panophthalmitis. Orbit. 2015;34(5):279-283.

14. Dada T, Ray M, Tandon R, Vajpayee RB. A study of the indications and changing trends of evisceration in north India. Clin Exp Ophthalmol. 2002;30(2):120-123.

15. Furdova A, Horkovicova K, Furda R, Sramka M, Rybar J, Kusenda P, Pridavkova Z. Two 11-Years Periods Statistics and Trends of Enucleation and Evisceration. J Craniofac Surg. 2021;32(8):2701-2705.

16. Adewara BA, Badmus SA, Adegbehingbe BO, Awe OO, Onakpoya OH, Adeoye AO. Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades. West Afr J Med. 2022;39(10):1068-1074.

17. Shah-Desai SD, Tyers AG, Manners RM. Painful blind eye: efficacy of enucleation and evisceration in resolving ocular pain. Br J Ophthalmol. 2000;84(4):437-438.

18. Zheng C, Wu AY. Enucleation versus evisceration in ocular trauma: a retrospective review and study of current literature. Orbit. 2013;32(6):356-361.

19. Ababneh OH, AboTaleb EA, Abu Ameerh MA, Yousef YA. Enucleation and evisceration at a tertiary care hospital in a developing country. BMC Ophthalmol. 2015;15:120.

20. Dave TV, Dave VP, Sharma S, Karolia R, Joseph J, Pathengay A, Pappuru RR, Das T. Infectious endophthalmitis leading to evisceration: spectrum of bacterial and fungal pathogens and antibacterial susceptibility profile. J Ophthalmic Inflamm Infect. 2019;9(1):9.

21. Hui JI. Outcomes of orbital implants after evisceration and enucleation in patients with endophthalmitis. Curr Opin Ophthalmol. 2010;21(5):375-379.

22. Tianthong W, Aryasit O. Outcomes of evisceration or enucleation by resident trainees in patients with recalcitrant endophthalmitis or panophthalmitis. Medicine (Baltimore). 2022;101(30):e29932.

23. Hicks CR, Morrison D, Lou X, Crawford GJ, Gadjatsy A, Constable IJ. Orbital implants: potential new directions. Expert Rev Med Devices. 2006;3(6):805-815.

24. Migliori ME. Enucleation versus evisceration. Curr Opin Ophthalmol. 2002;13(5):298-302.

25. Dave TV, Das AV, Mohapatra S, Bansal O, Ganguly A. Demography, Clinical Settings and Outcomes in Evisceration with Implant: An Electronic Medical Records Driven Analytics of 2071 Cases. Semin Ophthalmol. 2023;38(4):344-351.

26. Swan D, Turner R, Douketis J, Thachil J. How to undertake procedures while on antiplatelet agents: a hematologist's view. Res Pract Thromb Haemost. 2024;8(6):102539. doi:10.1016/j.rpth.2024.102539

27. Adewara BA, Badmus SA, Olugbade OT, Ezeanosike E, Adegbehingbe BO. Distribution of phthisis bulbi and status of fellow eyes at a tertiary eye-care centre in Nigeria: a ten-year review. Afr Health Sci. 2021;21(1):437-444.

28. Eagle RC Jr, Grossniklaus HE, Syed N, Hogan RN, Lloyd WC 3rd, Folberg R. Inadvertent evisceration of eyes containing uveal melanoma. Arch Ophthalmol. 2009;127(2):141-145.

29. Barry P, Cordovés L, Gardner S. ESCRS guidelines for prevention and treatment of endophthalmitis following cataract surgery: data, dilemmas and conclusions. European Society of Cataract and Refractive Surgeons. 2013:1-44.

30. Soares IP, França VP. Evisceration and enucleation. Semin Ophthalmol. 2010;25(3):94-97.

31. Long JA, Tann TM 3rd, Girkin CA. Evisceration: a new technique of trans-scleral implant placement. Ophthalmic Plast Reconstr Surg. 2000;16(5):322-325. doi:10.1097/00002341-200009000-00003

32. Massry GG, Holds JB. Evisceration with scleral modification. Ophthalmic Plast Reconstr Surg. 2001;17(1):42-47.

33. Sales-Sanz M, Sanz-Lopez A. Four-petal evisceration: a new technique. Ophthalmic Plast Reconstr Surg. 2007;23(5):389-392.

34. Ranno S, Serafino M, Nucci P. Four petal evisceration versus standard technique: A retrospective study. Eur J Ophthalmol. 2021;31(4):2156-2159.

35. Arnaiz-Camacho A, Alonso T, Oliveres J, Arcediano MÁ, Balaguer O, Bertolani Y, Pablos-Jiménez T, García-Hidalgo S, Pairó-Salvador A, Zapata MÁ. Modified four incomplete petals evisceration technique: A 14 year case series. Eur J Ophthalmol. 2025:11206721251361272.

36. Hawari M, Selim J, Djerada Z, Muraine M, Retout A, Thorel D. Risque d’extrusion à 5 ans dans les techniques d’éviscération à « 2 pétales » et « 4 pétales » [Five-year extrusion risk of "2 petal" and "4 petal" evisceration techniques]. J Fr Ophtalmol. 2024;47(8):104224.

37. Huang D, Xu B, Yang Z, Xu B, Lin X, Yang X, Zhao J. Fibrovascular ingrowth into porous polyethylene orbital implants (Medpor) after modified evisceration. Ophthalmic Plast Reconstr Surg. 2015;31(2):139-44.

38. Kim KH, Lee H, Park M, Chi Mc, Lee J, Baek S. Evisceration with four anterior relaxing incisions and circumferential posterior sclerotomies with porous polyethylene orbital implants: an 8-year study. Acta Ophthalmol. 2011;89(7):686-690.

39. Park WC, Han SK, Kim NJ, Chung TY, Khwarg SI. Effect of basic fibroblast growth factor on fibrovascular ingrowth into porous polyethylene anophthalmic socket implants. Korean J Ophthalmol. 2005;19(1):1-8.

40. Kaltreider SA, Lucarelli MJ. A simple algorithm for selection of implant size for enucleation and evisceration: a prospective study. Ophthalmic Plast Reconstr Surg. 2002;18(5):336-341.

41. Amer AA, Naveed H, Amer I, Osman HOA, Mohamed MAA, GadElkareem AM, Elbarawy AA, Gatzioufas Z, Elalfy M, ElShafie MA. Continuous versus Interrupted Sutures for Closure of Scleral Pocket and Conjunctiva after Evisceration and Placement of Acrylic Ocular Implant. Ophthalmic Res. 2025;68(1):285-291.

42. McGrath LA, McNab AA. Temporary suture tarsorrhaphy at the time of orbital ball implantation. Graefes Arch Clin Exp Ophthalmol. 2018;256(12):2437-2441.

43. Dave TV, Kumar S, Vasanthalin J, Kaliki S, Ali MJ, Naik MN. Development and Validation of a Grading Scale for Custom Ocular Prosthesis. Optom Vis Sci. 2016;93(11):1426-1430.