Enucleation (Removal of the Eye)

Indications

Eyes may be removed because of intraocular tumors (retinoblastoma in children and melanomas in adults), to relieve pain in eyes that have become blind, and eyes which have become infected. It is possible for patients to function well after the surgical removal of an eye, and an excellent cosmetic result may be achieved.

Eyes may also be removed as part of the postmortem examination. Insights from the examinations of such eyes have advanced vision research greatly. Patients who wish to donate eyes for research should contact their local eye bank for information. Patients may wish to contact their local Eye Bank. In some cases, especially following the death of infants and very young children, the eyes may become an important part of the forensic investigation into the cause of death.

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Preparation by Ophthalmologist
 

It is not necessary for the ophthalmologist to open the eye to improve fixation, nor is it desirable for the ophthalmologist to inject any fixatives into the eye. Such maneuvers may produce artificial retinal detachments.

The eye should be submerged in a suitable fixative (e.g., 10% neutral buffered formalin). If the eye is to be sent to a specialized eye pathology laboratory such as ours, it is important to ensure that the eye is completely submerged in fixative and that the container is sealed properly to avoid leakage during shipping.

Optimally, eyes should fix for at least 48 hours before dissection in the laboratory.

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Preparation by Ophthalmic Histotechnologist/Cytotechnologist

The processing of an eye requires specialized training. It is advantageous to use specialized paraffins and clearing agents in the tissue processor. Proper expansion of the eye using a double waterbath technique allows for the presentation of a rounded eye on a histology slide. Our technicians are available to answer questions on ophthalmic histotechnique.

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Issues for the Pathologist

 

There is no routine method for opening eyes. For example, eyes that have been subjected to previous ophthalmic surgery should be opened in such a way as to sample the surgical wound sites.

Light should be transmitted through all eyes to permit the pathologist to identify shadows which may be caused by intraocular tumors.

Cross-section of a malignant melanoma of the choroid and ciliary body. The eye was opened in a special fashion to facilitate clinico-pathologic correlations (see references below)

 

References:

Folberg R, Verdick RE, Weingeist TA, Montague PR: Gross examination of eyes removed for ciliary body or choroidal melanoma. Ophthalmology 93:1643-1647, 1986.

Folberg R: The Eye. In Spencer WH (ed): Ophthalmic Pathology - An Atlas and Textbook, 4th edition, Philadelphia, WB Saunders, 1996. pp 1-37.

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More Questions?

If you have more questions about enucleation specimens, please contact one of us:

Ophthalmic Pathologists

Robert Folberg, MD, FCAP, Director

Deepak P. Edward, MD

Consultation Coordinator

Marnie Pomeroy

 

 

 

 


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