Evisceration Versus Enucleation Following Ocular Trauma, a Retrospective Analysis at a Level One Trauma Center

Abstract

Introduction Penetrating and perforating ocular trauma is often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. Enucleation is commonly utilized for management of a non-salvageable eye following penetrating and perforating ocular injuries. Recently, the use of evisceration for non-salvageable traumatized eyes has increased. As a technically easier alternative, evisceration offers several advantages to the ocular trauma surgeon to include faster surgical times, better cosmesis and motility, and improved patient outcomes. Debate still persists concerning whether or not evisceration is a viable option in the surgical management of a non-salvageable eye following ocular trauma given the theoretical increased risk of sympathetic ophthalmia and technical difficulty in construction of the scleral shell with extensive and complex corneoscleral lacerations. A retrospective analysis at a level 1 trauma center was performed to evaluate the practicality of evisceration in ocular trauma. Materials and Methods Eyes that underwent evisceration or enucleation following ocular trauma at San Antonio Military Medical Center, a level 1 trauma center, between 01 January 2014 and 30 December 2016 were examined. Factors evaluated include mechanism of injury, defect complexity, ocular trauma score, and time from injury to surgical intervention. Surgical outcomes were assessed. Results In total, 29 eyes were examined, 15 having undergone evisceration and 14 enucleation. The average size of the scleral defect before evisceration was 20 mm in length, and 23 mm before enucleation. The mechanism of injury and characterization of the defects among the two groups were relatively similar and described. Overall comparison of the two study groups in terms of surgical outcomes and complications was also relatively similar, as demonstrated. No cases of postoperative persistent pain, sympathetic ophthalmia, infection, or hematoma were identified for either group. Conclusions The postoperative outcomes demonstrated for the evisceration group are comparable to enucleation, which is consistent with the recent literature. Defect size and complexity did not affect surgical construction of the scleral shell during evisceration. If consistently proven to be a safe and viable alternative to enucleation, evisceration can offer shorter surgical times and better cosmesis for patients. More research into the long-term complication rates and more cases of evisceration for use following ocular trauma should be assessed. Still, this analysis demonstrates that evisceration is a viable surgical alternative and perhaps superior to enucleation for the management of a non-salvageable eye following extensive ocular trauma in many cases.

Traumatic enucleation of the left globe after a road traffic accident – A case report of an uncommon occurrence in maxillofacial trauma

“…It is believed to be secondary to the development of an autoimmune reaction to ocular antigens that are exposed during the traumatic or surgical event. It triggers an immune response mediated by T cells that attack the contralateral eye [ 7 , 11 , 12 ]. In a large retrospective study, the prevalence of enucleation in OGI was 6.2% [ 13 ].…”

Conjunctival Epithelial Inclusion Cyst following Evisceration with Primary Orbital Implantation

“…Enucleation had been conventionally performed in eyes with penetrating ocular injury to minimize the risk of sympathetic ophthalmia. However, a recent study showed that evisceration reduces the risk of sympathetic ophthalmia to a similar degree [ 16 ]. In addition, evisceration is associated with shorter surgical times and better postoperative cosmesis [ 16 ].…”

“…However, a recent study showed that evisceration reduces the risk of sympathetic ophthalmia to a similar degree [ 16 ]. In addition, evisceration is associated with shorter surgical times and better postoperative cosmesis [ 16 ]. We, therefore, chose evisceration in the present case.…”

Finding the missing bullet: A case report of an unusual trajectory from the left scapula into the left orbit

“…He was taken to the operating room for emergent surgical exploration and his surgical team attempted to repair the ruptured globe; however, he had an extensive scleral laceration that was unamenable to repair posteriorly. He was ultimately offered the opportunity to undergo enucleation or evisceration by his ocular surgical team out of concern that he could develop sympathetic ophthalmia [3] , [4] . After discussion of the risks and the benefits of surgical intervention, he declined further operative intervention.…”