The Eye Amputated – Consequences of Eye Amputation with Emphasis on Clinical Aspects, Phantom Eye Syndrome and Quality of Life

Abstract

. In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end‐stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery. The purpose of the PhD thesis was: To indentify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity and frequency among EA patients. We attempted to identify patients with increased risk of developing pain after EA and investigated if preoperative pain is a risk factor for a later development of phantom pain (paper III); In addition we wanted to investigate the health related quality of life, perceived stress, self rated health, job separation due to illness or disability and socio‐economic position of the EA in comparison with the general Danish population (paper IV). The studies were based on: Records on 431 EA patients, clinical ophthalmological examination and an interview study of 173 EA patients and a questionnaire answered by 120 EA patients. Conclusions: The most frequent indications for EA in Denmark were painful blind eye (37%) and neoplasm (34%). During the study period 1996–2003, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty‐four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain for several years after the surgery. Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n = 19); (ii) radiating, zapping or shooting (n = 8); (iii) superficial burning or stinging (n = 5); or a mixture of these different pain qualities (n = 7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 [range: 1–89]. One‐third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Factors associated with phantom pain were: ophthalmic ...

Phantom Eye Syndrome

“…5 Triggers of PES also reflected previous findings, that is, darkness, closing the eyes, and psychological stress. 4,5,8 Although our patients reported that many instances ended spontaneously, patients also could end them by distraction or sleep.…”

“…5 Triggers of PES also reflected previous findings, that is, darkness, closing the eyes, and psychological stress. 4,5,8 Although our patients reported that many instances ended spontaneously, patients also could end them by distraction or sleep. Our finding that younger patients were more likely than older ones to report visual sensations and pain concurs with the findings of Sörös et al, 3 but not with those of Rasmussen et al 4 and Rasmussen, 5 who reported that visual sensations were more common in older patients.…”

“…Questions were adapted from the interview questions reported by Rasmussen et al 4,5 Patients were asked about 3 types of symptoms in the removed eye: (1) pain (the question asked by Rasmussen et al referred to pain "in the eye or in the area around the missing eye," but for greater specificity, we asked only about pain in the removed eye); (2) visual sensations, including colors, shapes, and images; and (3) the feeling of seeing with the removed eye. Patients also were asked to describe any visual sensations as free text.…”

Custom Made Ocular Prosthesis at Optometry Clinic Universiti Kebangsaan Malaysia (UKM)

“…Daily cleaning as practiced by patient in Case 2 is not recommended (Osborn and Hetler 2010), because frequent removal may irritate the socket which in turn can cause allergic reaction. Allergic reaction can results in mucus discharge and discomfort to the patient (Hegde et al 2011;Kalavathi et al 2010;Somkuwar et al 2009;Rasmussen 2010). Patient in Case 2 practiced daily removal of ocular prosthesis upon awakening in the morning.…”

Donor sclera‐wrapped acrylic orbital implants following enucleation: experience in 179 patients in the Netherlands

“…Patients have to learn to cope with the loss of binocular vision, with their altered appearance and in those cases where enucleation was performed for a malignancy, patients have to come to terms with the underlying oncological problem. Having cancer or going blind is among the most feared medical conditions, and removal of an eye affects patients in terms of psychological state and quality of life (Rasmussen 2010). When performing an enucleation, it is therefore of utmost importance to choose a surgical procedure and an implant with as few as possible postoperative complications in a quest not to add to the patient's distress.…”