Enucleation Surgery: Eye Removal, Orbital Implants and the Artificial Eye

Hearing that an eye may need to be removed is one of the hardest moments in eye care, for adults and even more for parents. Enucleation surgery is recommended only when keeping the eye would carry a greater risk — to life, to comfort or to the other eye — than losing it. Today it is combined with a reconstruction that restores a natural appearance. This page explains when removal is advised, how it differs from evisceration and exenteration, what an orbital implant does, and how you or your child move from surgery to a custom artificial eye.

When is removal of the eye recommended?

• Large uveal melanoma: a very large tumor, extensive ciliary body or iris involvement, optic nerve invasion, a painful blind eye with severe glaucoma, or regrowth after radiation; some patients also prefer removal.
• Advanced retinoblastoma: typically Group E eyes, glaucoma from new blood vessels, suspected optic nerve invasion or failure of other treatment, following the rule "life first, then the eye, then vision".
• A blind, painful eye that no longer responds to medical treatment.
• Severe injury with no chance of useful vision, uncontrolled infection, or preventing sympathetic ophthalmia, a rare inflammation that can attack the healthy eye after injury to the other.

Removal is no longer the default for most eye cancers. In the Collaborative Ocular Melanoma Study, patients with medium-sized melanomas treated with plaque brachytherapy lived as long as those whose eye was removed (all-cause mortality at 12 years 43% versus 41%), and many children with retinoblastoma now keep the eye thanks to intra-arterial and intravitreal chemotherapy.

Enucleation, evisceration or exenteration: what is the difference?

Evisceration keeps the sclera and its muscle attachments, which can give slightly better volume and movement, but it is not used when a tumor is known or suspected, because cancer cells could be left behind. If the inside of the eye cannot be seen, an ultrasound or CT scan comes first: in one large review, an unexpected tumor was found in 1.95% of 13,591 evisceration specimens.

Exenteration is reserved for cancers that have invaded the orbit, such as advanced eyelid cancer or lacrimal gland cancer (see orbital tumors). Sparing the eyelids, where possible, speeds healing. The area is later covered with an eye patch or a custom silicone orbital prosthesis held by adhesive, spectacles or bone-anchored magnets. Targeted drugs, immunotherapy and radiotherapy increasingly help to avoid exenteration when this is safe.

How does enucleation surgery work?

Under general anesthesia, the surgeon detaches the eye muscles, divides the optic nerve and removes the eye intact, handling it gently when a tumor is present. In retinoblastoma, about 10 mm of optic nerve is removed with the eye, because tumor in the nerve decides whether further chemotherapy is needed.

An orbital implant, a sphere that replaces the volume of the eye, is placed deep in the socket, and the eye muscles are attached to it or to its covering so that it can move. The tissues are closed in layers, and a clear plastic shell called a conformer is placed behind the eyelids to preserve the pockets that will later hold the prosthesis. The removed eye goes to the pathologist; in uveal melanoma, tissue can also be used for genetic prognostic testing.

Which orbital implants are used?

• Non-porous implants are made of acrylic (PMMA) or silicone.
• Porous implants (hydroxyapatite, porous polyethylene or aluminum oxide) let tissue and blood vessels grow into them, which helps them integrate.
• Implants may be wrapped in donor sclera, fascia or mesh to help the muscles attach and protect the tissue over them.

In a 2004 survey of American oculoplastic surgeons, porous polyethylene was the most used implant (43%), followed by hydroxyapatite (27%) and non-porous implants (20%). Adults usually need a sphere of at least 20 mm. Pegs linking the implant to the prosthesis improve movement, but 44% of pegged implants had complications in one series, so pegs are now rarely used.

Step by step: from surgery to your artificial eye

1. Consultation and planning. Examination, scans and pathology are reviewed and eye-sparing alternatives discussed; for a child, the whole family meets the team.
2. Surgery. Enucleation, implant and conformer under general anesthesia, with a pressure dressing for a short time afterwards.
3. The first two weeks. Swelling and bruising peak in the first days and settle over 1–2 weeks. Pain is usually controlled with tablets, and antibiotic drops or ointment are used as prescribed.
4. Weeks 2 to 8. The lining of the socket heals over about 4–8 weeks. The conformer stays in place, because leaving it out can let the socket shrink.
5. First ocularist visit, about 4–8 weeks after surgery. An ocularist, a maker of artificial eyes, takes a gentle impression of the socket and shapes an acrylic shell, hand-painted to match your other eye.
6. Fitting and fine-tuning. The prosthesis is inserted and adjusted for comfort, lid position and gaze.
7. Long-term care. Regular polishing, a new prosthesis every few years, checks of the socket and the healthy eye, and any cancer follow-up your diagnosis requires.

How natural will the artificial eye look and move?

Modern custom prostheses look natural in most everyday situations. The implant moves with the eye muscles and passes part of that movement to the prosthesis, so the artificial eye follows the other eye, though less fully when you look far to the side. Its pupil does not change size with light.

Over the years, some people notice a deeper hollow above the eye, a looser lower lid or a prosthesis that seems to sit further back (post-enucleation socket syndrome). A modified prosthesis, volume-adding fillers or implants, or eyelid surgery can usually help. In a survey, 94% of ocularists felt these changes are more common after enucleation than after evisceration.

How do I care for an ocular prosthesis?

Most people leave the prosthesis in place most of the time and remove it only as their ocularist advises. When you do, handle it over a soft surface, clean it as instructed (without alcohol or solvents), and use lubricating drops for dryness. Many specialists also recommend impact-resistant (polycarbonate) glasses to protect the remaining eye.

See your ocularist sooner if the eye seems to look in a different direction, is scratched or coated, causes more discharge or discomfort, looks sunken, slips, makes the lid droop, or is more than 5 years old.

How is a child's face protected as it grows?

When an eye is removed in early childhood, that side of the orbit can grow less. A well-sized implant, or a dermis-fat graft (a small piece of deep skin and fat, usually from the abdomen or buttock, which can grow with the child), together with regular enlargement of the prosthesis, helps the face develop symmetrically. Some of the graft's fat is expected to shrink, more so in adults. Young children therefore see the ocularist often.

What are the risks?

Early problems include bleeding, swelling and infection. Later issues include:

• Implant exposure or extrusion: the tissue over the implant thins or opens. Small exposures can be patched with a graft of sclera, fascia or dermis-fat; larger ones may need a new implant.
• Contracted socket: scarring makes the pockets too shallow to hold the prosthesis. Radiotherapy, infection, repeated surgery and leaving the conformer or prosthesis out are typical causes. Deepening procedures use grafts from the lining of the mouth, amniotic membrane or a dermis-fat graft.
• Volume and eyelid changes: a deep upper-lid hollow, a drooping upper lid or a loose lower lid.
• Discharge and dryness of the socket, usually manageable with cleaning and drops.

Recovery, emotional support and travel

Most discomfort settles within the first week or two. Light daily activities can resume once the swelling has eased; swimming, contact sports and heavy lifting wait until your surgeon agrees.

Adapting to one eye takes time. Judging distances, on stairs or when pouring a drink, often feels harder at first and improves over the following months; driving rules for people with one eye differ between countries. Losing an eye is also an emotional event. Worry, grief and self-consciousness are normal, and talking with the care team, a psycho-oncology service or other patients can help; children benefit from simple, honest explanations.

Patients from abroad usually stay in Antalya until the first post-operative checks are complete, then fly home with the conformer in place; ask your surgeon about timing, especially for long flights, because of the risk of blood clots after surgery. The first prosthesis can be made 4–8 weeks later by an ocularist near home or during a second visit.

Are there alternatives to removing the eye?

For many tumors, yes, depending on size, location and vision:

• Uveal melanoma: plaque brachytherapy, proton or stereotactic radiotherapy and, in selected cases, local resection.
• Retinoblastoma: intra-arterial, intravitreal and systemic chemotherapy with laser or freezing treatment.
• Clinical trials: neoadjuvant darovasertib, a tablet taken before local treatment to shrink large uveal melanomas. In a phase 2 study, 24 of 42 patients (57%) who had been advised to have the eye removed and completed treatment were able to keep it. As of September 2026 it is investigational and available only in clinical trials, including the phase 3 OptimUM-10 trial.

Enucleation surgery in Antalya

Prof. Türkoğlu performs enucleation and evisceration with orbital implants for adults and children. Before recommending removal, she reviews whether an eye-sparing treatment could control the disease safely, and she explains the reasons, the implant and the timeline in plain language. The artificial eye is made by an ocularist, the pathology and genetic tests are carried out by laboratory specialists, and any further cancer treatment is planned with the relevant oncology teams.

If you live abroad, you can begin with a remote review of your scans and reports. See international patients for travel planning and our article on eye tumor surgery for what to expect on the day.