Indications for enucleation and evisceration in a tertiary eye hospital in Riyadh over a 10-year period

Abstract

BACKGROUND: Enucleation and evisceration are eye removal procedures considered as palliative treatment when all other therapeutic options are exhausted. OBJECTIVE: Describe the causes and histopathological findings leading to enucleation/evisceration, and correlate the clinical findings with the histopathological findings. DESIGN: Retrospective, descriptive study. SETTINGS: Tertiary care hospital, Riyadh, Saudi Arabia. PATIENTS AND METHODS: The medical records of patients who underwent enucleation or evisceration from February 2005 to May 2015 were reviewed. Patients were classified into two categories based on indications of surgery: traumatic and nontraumatic. Causes of ocular injury in the traumatic group were documented, and the histopathological findings were reviewed for the nontraumatic cases. MAIN OUTCOME MEASURE(S): Number of enucleation and evisceration surgeries and their causes and histopathological findings. RESULTS: One hundred ten patients underwent evisceration (n=69, 63%) and enucleation (n=41, 37%). Causes were traumatic in 38 (35%) and nontraumatic in 72 (65%). The median age was 50 years and there were 64 men and 46 women. Postoperative endophthalmitis was the most common indication for surgery (n=24, 21.8%), followed by painful blind eye (n=22, 20%). Ocular trauma was more predominant in men (n=29, 76%) than in women (n=9, 24%), and the leading mechanism of trauma was metallic nail injuries (n= 6, 15.8%). In the nontraumatic group, endophthalmitis was the most common histopathological finding (n= 25, 34.7%). CONCLUSIONS: The majority of the eye enucleation/evisceration surgeries were due to nontraumatic causes, especially postoperative infections. However, severe eye trauma was still a main indication for this destructive procedure. Guidelines are needed to decrease the incidence/severity of work-related eye injuries and to detect and manage eye infections earlier and more promptly. LIMITATIONS: Retrospective study, in one hospital in one area; therefore, results cannot be generalized.