Choice of procedure: enucleation, evisceration, or prosthetic fitting over globes

Enucleation is more likely to be associated with certain intraoperative and postoperative complications but remains the procedure of choice in cases where detailed histopathologic examination of the globe is required, in many cases of intraocular neoplasm, and in selected cases of ocular trauma with visual loss. In many patients, evisceration results in enhanced cosmesis compared to enucleation and is a technically simpler and faster operation. Evisceration may be indicated in patients with blind and unsightly or painful eyes and in selected instances of ocular trauma following discussion of the risk of sympathetic ophthalmia with the patient. It is contraindicated in patients with possible intraocular malignancy. In appropriate cases, a cosmetic shell or contact lens may constitute an alternative to enucleation or evisceration, and may provide superior cosmesis. Management of patients requiring these procedures should be tailored to the particular clinical situation with consideration of the wishes of the well-informed patient.