**2. Surgical indications**

#### **2.1. Enucleation**

The most common indications are intraocular malignancy, blind painful eyes, penetrating trauma, very bad ocular cosmesis or phthisical eyes, and prevention of sympathetic ophthal‐ mia (SO).

A significant decrease in the number of enucleations was observed between 1975 and 1995. This was primarily caused by a decrease in the number of glaucoma-related enucleations [6]. Evisceration, unlike enucleation, disrupts the integrity of the globe's barriers, which could trigger an autoimmune reaction (SO) in the contralateral eye. Although some authors believe that SO continues to be an important disadvantage, evisceration has gained popularity in the past few decades because of superior functional and cosmetic results compared to enucleation. Levine et al. [7] concluded that the risk of SO following evisceration is extremely low.

Choroidal melanoma in adults and retinoblastoma in children are the most common intraoc‐ ular malignancies. In some cases of malignancy diathermy, chemotherapy and radiation may be an alternative to more disfiguring surgeries.

#### **2.2. Evisceration**

to explain with detail the surgical technique, the time the patient is expected to stay in the hospital, the need for frequent bandage changes in the hospital clinic, the possible complica‐

Evisceration, enucleation, and exenteration are the three main surgical options. Evisceration is the removal of the contents of the globe while leaving the sclera and extraocular muscles intact. Enucleation is the removal of the eye from the orbit while preserving all the other orbital structures, and exenteration is the removal of the globe as well as the soft tissues of the orbit

There is evidence that Egyptians and Sumerians used artificial eyes to decorate their mummies and their statues, respectively; however, there is no evidence to suggest that they used them for medical purposes in living people. Clay models resembling eyes were used in the Roman Empire around 500 BC to cover phthisical eyes. It was not until the 16th century that enuclea‐ tion surgeries were reported in the medical literature. In 1583, George Bartisch first described the extirpation of an eye. In 1817, Bear introduced evisceration in an eye with an expulsive

It was in 1874 when Noyes reported the routine evisceration of the ocular contents when there was severe intraocular infection [3]. Later, in 1884, Mules reported for the first time the use of an orbital glass sphere implant in an eviscerated cavity, this becoming the bedrock of volume loss restoration and improving dramatically cosmetic results of this surgery [2,4]. In 1887, Frost inserted a crystal ball orbital implant inside Tenon's capsule after an enucleation procedure [5]. Since then, advances in surgical techniques, anesthesia, new implants, and wrapping materials and prosthetics over the past decade have greatly improved surgical outcomes and patient satisfaction. Today, most patients have good cosmetic results following the removal of and eye. However, even an exquisite surgical technique cannot prevent complications in the immediate and long-term follow-up of these sockets, making these patients challenging for

The decision to remove an eye must be individualized to each patient. Advantages and

The most common indications are intraocular malignancy, blind painful eyes, penetrating trauma, very bad ocular cosmesis or phthisical eyes, and prevention of sympathetic ophthal‐

A significant decrease in the number of enucleations was observed between 1975 and 1995. This was primarily caused by a decrease in the number of glaucoma-related enucleations [6]. Evisceration, unlike enucleation, disrupts the integrity of the globe's barriers, which could trigger an autoimmune reaction (SO) in the contralateral eye. Although some authors believe

disadvantages exist among the different surgical techniques and implant materials.

tions of the socket, and a long recovery period before a prosthesis can be fitted in.

hemorrhage when performing an iridectomy for an acute glaucoma [2].

(connective tissue, fat, and muscles).

26 Advances in Eye Surgery

the Oculoplastic Surgeon.

**2. Surgical indications**

**2.1. Enucleation**

mia (SO).


#### **2.3. Exenteration**

Orbital content removal is reserved for the treatment of potentially life-threatening malignances arising from the eye, eyelid, orbit, paranasal sinuses, and periocular skin. Secondary orbital spread from eyelid, intraocular, and conjunctival malignant tumors was the most frequent indication of exenteration, followed by primary orbital malignant tumors. Other indications have included sclerosing inflammatory pseudotumors and invasive fungal disease of the orbit [11-13].
