Enucleation of blind, painful eyes

Purpose: To determine the demographics and results of treatment in patients undergoing enucleation of blind, painful eyes. Methods: Medical records were reviewed to determine the precipitating cause, preoperative symptoms, prior therapy, and results of treatment in 58 patients in whom enucleation was performed to relieve ocular discomfort. Patient perception of symptoms and treatment was assessed by a follow-up mail survey. Results: Forty-five percent of patients had sustained prior trauma. Ocular discomfort was attributed to phthisis (43%), elevated intraocular pressure (40%), or corneal decompensation (10%). Preoperative symptoms included ocular pain (91%), periocular headache (17%), tearing (26%), and ipsilateral photophobia (26%). Eight patients experienced contralateral photophobia. Enucleation provided complete symptomatic relief in 54 patients (93%). Two of the four patients with persistent discomfort experienced painful facial paresthesias, attributed to prior retrobulbar alcohol injections. Ninety-one percent of the 32 patients who completed the follow-up survey reported pain relief after surgery, whereas 94% would recommend enucleation to others with blind, painful eyes. Conclusions: Trauma is the most common precipitating condition in patients undergoing enucleation of blind, painful eyes. These patients experience a variety of symptoms, including ocular pain, facial pain or paresthesias, tearing, and photophobia. Contralateral photophobia is not uncommon. Enucleation is highly effective in relieving these symptoms and should be considered in patients unresponsive to topical therapy. Facial paresthesias in patients who have received prior retrobulbar alcohol injections are not relieved by enucleation.