Removal Surgery and Recovery

Some people lose an eye to accidents, and don't have any choice but to have it immediately removed. Others, like me, start off with an eye which seems perfectly healthy, but because of cancer or other disease must be removed to protect the rest of the body.


In my case, my cancerous tumor was relatively small, but it was so close to the optic nerve that any kind of radiation therapy would have destroyed the sight in my eye anyway. The radiation therapy would have saved the eye, but the eye would be blind and there would be a chance of future re-growth of the cancer. So, to give myself the best chances of survival, I elected to forego the radiation therapy and have the cancer completely removed from my body. I had about a week between the time I made this decision and when it was finally removed.The first problem you will face, even before you get to the operating table is stress. In my case, I dealt with stress by:


1) Continuing to work, which took my mind off the upcoming surgery


2) Taking time to do some really fun things, which took my mind off the upcoming surgery


3) Rationalizing that the loss of an eye for my survival (knock on wood) against cancer was a pretty good trade

And most important . . .


4) Realizing that my life would not be significantly different with only one eye

If you do as I did and repeatedly covered your bad eye to see what the world looks like, you will see that it looks pretty much the same. In fact, in the days before my surgery I purchased several eyepatches and wore them around to see what it would be like.




Not much difference.


As for the surgery itself, I'm not a doctor, and I don't have any medical training or experience whatsoever. In fact, I get queasy at the sight of blood. However, I'm going to give you some thoughts on removal surgery, what the docs refer to as "enucleation" (a really crappy Latin name that the medical profession should abandon).


In some ways, enucleation surgery is pretty significant. You get general anesthesia and are completely unconscious during the surgery. They are, after all, removing an organ.


On the other hand, enucleation is pretty quick and basic and doesn't do much harm to your body. They gas you out, disconnect a couple of muscles from your eye and that's about it. In fact, you may have the option of having the surgery performed on an out patient basis -- it can be as little as five or six hours from the time you first lay down on the operating table to you are up and walking around the hospital. In my case I had surgery in the morning and stayed the night so that I could be examined the next morning, but you might be more comfortable in your own bed if you live close to the surgical center.


From the patient standpoint, it goes like this. You lay on the operating table, they wheel you into surgery, and they give you anesthesia through an IV. You pass out very quickly, and a couple of hours later you wake up groggy. There is a big pressure patch over your eyelid, and it might be a little sore (but probably not much because of the local anesthesia which is applied after the eye is removed). It takes about an hour for the general anesthesia to wear off, and then you are fine except that your stomach may be a little queasy and you have this pressure patch on your eyelid.


During your surgery, the anesthesiologist will snake a breathing tube down your throat. You will neither know or feel this, since it will happen after you are totally unconscious. However, when you wake up your throat will probably be a little sore (like you just had "strep throat") and that is why.


If your eye or throat or anything else is sore after your surgery, please say something to the nurse immediately -- not because there is necessarily anything wrong, but because they can give you stuff to make the pain go away.


You can expect to have some slight soreness in your eye for about five days. It will only really hurt when you jerk your good eye to one side or another (this causes the muscles for your lost eye to similarly react), so keep your eye movements slow. For me, Tylenol did the trick (don't use aspirin or aspirin-based painkillers as it will thin the blood) better than the drugs my surgeon gave me.


What you learn is that although you don't have an eye, that your eye muscles move as if your eye was still there. So, if you glance from side-to-side you will feel pain for several days until those muscles heal.


In my case, when I was released I didn't have any discoloration around my cheek. After a couple of days, a small area turned black-and-blue and it looked like I had earned a "shiner" in a fight. From days four through ten, the area turned slightly yellowish and the eyelids swelled a little bit, but after about ten days the eyelid and cheek returned to normal.


What does your face look like after your eye has been removed? Keep in mind that your eyeball helped keep the eyelid up. So, when the eye is removed the eyelid simply stays shut as if you are winking. The effect is simply that you walk around with one eye closed. This will not cause you any discomfort, although you will probably be self-conscious about it. I overcame this by wearing fashionable dark wraparound sunglasses of the type like you might see in a Clint Eastwood cop movie or on Stevie Wonder.


After your release from the hospital you will probably be given (1) a healing gel to be applied to your eye socket and (2) a saline type of "flush" for your eye socket.


Psychologically, it is difficult to confront your empty eye socket. To administer the gel, you have to pull down on the lower eyelid and leave a line of gel inside. It is psychologically difficult because you don't know what to expect to see. Truth is, when you finally get the courage to pull down the lower eyelid you will realize that it looks exactly like it did before, you just don't see the white of your eye anymore. It is NOT like you have a huge empty space where your eye once was -- your muscles and other tissues kind of fill this area up so that what you see is just pink.


The flush is easy because you don't have to look at anything. Just hold your eyelid down, and without looking squirt some of the saline inside.


About seven days after the surgery, you will probably have a post-surgery checkup. After this, you can probably consider yourself more-or-less healed from the surgery, except that you should not attempt to lift heavy objects or engage in strenuous activity for about four weeks after the surgery. My surgeon told me, for example, that I should not return to surfing until approximately six weeks after the surgery, but after that time I should be perfectly fine doing about whatever I wanted to do.


Patient Tip: I will tell you that before my surgery I had concerns about having the wrong eye removed. I discussed this in advance with my surgeon, and he described to me the great lengths to which his staff goes to ensure that it is the diseased eye which is removed, such as dilating the eye, having two surgeons independently examine the diseased eye and locate the tumor and match it up against photographs of the tumor before removing the eye. It made me feel good to hear him say this, and you should definitely ask your surgeon about this risk.


Still, before the surgery I had somebody write on my forehead with a big magic marker the words "Healthy" and "Cancer" over each of my eyes so that there could be no doubt which one to remove. This was probably overkill on my part, but it certainly alleviated one of my worries. After the surgery, I attempted to apologize to my surgeon for doing this, but he stopped me and said "Removing the wrong eye is our worst nightmare too -- I've known surgeons who operated on the wrong kidney or something, and were so upset about it that they later committed suicide. So anything you do to help us get the correct eye is OK by me." Thus, although probably unnecessary, I strongly recommend that you do this, if nothing else for your own peace of mind.


Post-Surgery Depression: I haven't had any post-surgery depression yet (I am typically an upbeat sort of person who has never suffered from serious depression), although I could see how others might have depression following removal. Two thoughts:


1) I suggest that your best defense against depression is to get up and get around and see (with one eye) for yourself that your life will probably not be that much different than before. So get out of the house, go walk around the mall, go out to dinner, go visit some friends.


2) It can't possibly hurt to go see a qualified mental health professional, and I'll bet that your eye surgeon will be able to recommend to you someone who is familiar with these type of cases.


Post-Surgery Waiting Period. A few weeks after your surgery you will visit an ocularist and be fitted with a new eye. In the interim, you will have your choice of a plastic cup, an eye patch, or wrap around dark sunglasses.


With me, the plastic cup lasted a couple of days, and the eye patch lasted a couple of days. After that, and for about the six weeks until I got my new eye, I wore wrap around dark sunglasses. What does it look like when you've lost your eye? Mostly, it looks like your eye is permanently closed and for the first couple of weeks the slight post-surgical swelling will keep your eye looking normal. After a couple of weeks, the swelling will go down and your eye muscles will recede, and then your socket will slowly start looking kind of depressed (though your eye will still be closed).


Wear dark sunglasses and nobody will know.


See also Information About Enucleation -- The Eye Cancer Network's webpage describing the surgical process of removing an eye, and what to expect afterwards. Content.aspx?sSection= Patient& sSubSection= Treatments&sPage= Treatment.ascx&nID= 2


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