Enucleation of the eye

If the retinoblastoma tumour is very large and has damaged the sight in the eye beyond repair, then the ophthalmologist will recommend that the eye be removed. This operation is called an enucleation. Enucleation is only recommended when it is felt other treatments would not be effective, and/or would put the child’s life at risk.

Children recover very rapidly following this surgery. There are no stitches to be removed after surgery and your child will be kept comfortable with regular paracetamol. Other painkillers can be given if necessary.

Usually the child will be able to come home one or two days after the operation and parents/carers will be taught how to put antibiotic drops into the socket. These drops are necessary until they receive their artificial eye. A temporary artificial eye (conformer) will be put in during the operation. It is worn to protect the socket whilst it is healing. Conformers can be clear or may be coloured like an eye.

Pathology following enucleation surgery

When an eye has to be removed, it is sent to a pathologist who will examine it under the microscope. The pathologist looks for evidence of retinoblastoma cells in the optic nerve, the deeper layers of the eye and in the front chamber of the eye. If any of these features are found, chemotherapy will then be considered. Your doctor will discuss this with you.

When chemotherapy is necessary after enucleation, a number of tests will be done to check that the tumour has not spread outside the eye. The investigations may include blood tests, a lumbar puncture to examine the cerebrospinal fluid (CSF) which surrounds the brain and spinal cord, and a bone marrow test. In some cases, an MRI scan of the head may be done. The paediatric oncologist will advise which tests are necessary and more information about these tests will be given to the parents.

CHECT also have our very own support toy Pip the penguin. Pip was designed as a tool to support the understanding of an enucleation in children who have undergone or who will undergo an enucleation. To find out more about Pip, visit our parents area.