The intrascleral prosthesis is a cosmetic option instead of removal of a painful diseased eye.

This procedure involves removing the contents of the eye and placing a silicone ball inside the eye. Thus vision is not restored following this procedure.

The final result usually can look fairly natural.

Indications for Intrascleral prosthesis

• When a chronic, painful disease such as glaucoma or uveitis cause irreversible blindness, surgery may be recommended to make your pet more comfortable.  One commonly performed technique is enucleation, or removal of the eye.  Another option which, in many cases, may provide a more cosmetic result is evisceration with an intrascleral prosthesis.  This procedure allows a cure for the painful disease process, but allows for an eye and functional eyelids to remain, resulting in a more natural look.

Surgical Procedure

• An evisceration involves creating a large incision over the top of the eye underneath the upper eyelid, removing the contents of the eye, placing a silicone prosthesis inside the shell of the eye, and closing the incision.  With this procedure, the pet retains the shell of the eye.  An analogy would be taking an orange, opening up the peel, removing all the fruit from inside and closing it back up again.  After the procedure, your pet will be on some oral pain medications and may be wearing a fentanyl (a drug similar to morphine) patch.  There will also be a topical antibiotic/steroid ointment that will be applied to the eye several times per day.

Postop Expectations

• The sight of an evisceration healing can be shocking if you do not know what to expect.  Removing the contents of the eye takes away the supply of nutrition to the normally clear windshield of the eye called the cornea.  In order to obtain nutrients, the cornea must now grow blood vessels which will grow in over the next month in a red ring closing in on the central cornea (Fig. 1).  Once the vessels have reached the middle of the cornea, they begin to regress and the cornea will turn a gray to hazy black color (Fig. 2).
• Not all dogs are candidates for this procedure.  It requires that the pet not have significant corneal disease and should not be performed when a tumor is suspected inside the eye.  Complications include corneal ulceration, decreased tear production, and, very rarely, rejection of the prosthesis.  In certain cases, evisceration with intrascleral prosthesis provides a more cosmetic outcome than enucleation (Fig. 3).