Factsheets Considering the needs of people who may need to undergo the surgical removal of an eye

Introduction

In the previous factsheets we have discussed the impact of monocular vision and how to support people with learning disabilities who have sight on one eye only.

In this factsheet we will consider some important points about having an eye removed and some points to consider about having a false, or prosthetic, eye or shell. 

Having surgery

• Some people may need to have surgery. 
• This could involve the total removal of the eye (enucleation) or partial removal, leaving part of the outside structure in place (evisceration).

Preparing the person for eye surgery

• It is important to know if the person has any sight in the eye to be removed, as it will have an effect on how they function after the operation. 
• If they still have some sight, it might be worth considering the use of an eye patch for short periods as a means of preparation and to begin work on compensatory techniques.  This really needs to be discussed carefully, as it may lead to false assumptions about people's ability to relearn skills, while overlooking their likely distress at the loss of the eye.
• How much can this person see with their other eye?  The loss of one eye can have a dramatic effect on what they are able to see and do. 
• Their own appearance may be frightening and distressing after the operation, and they are likely to look bruised.

Surgery

• Surgery is performed under general anaesthetic.
• The eye socket that has been operated on will be covered up with a pad for a couple of days after surgery.

After the surgery

• Make sure that pain and discomfort is minimised, and that medication to deal with this is used consistently and regularly.
• The person is likely to experience deep feelings of distress and loss.  Make sure that this is addressed in a sensitive manner. A local society of  people with visual impairments may offer counselling services . 
• If the person is additionally upset by their post-operative appearance, minimise the possibility of their seeing themselves in a mirror until the bruising has gone.
• We have occasionally been told of people with learning disabilities who have been treated insensitively when they have had an eye removed.  They may have been informed that “they would be better off without it” or that the eye had become “sick” or “useless”.  While it may be in the person's best interests to have their eye removed, such comments ignore people's feelings of sadness and loss. 
• Some people have said they feel ‘disfigured’ or ugly, and may need counselling to come to terms with the new self.

Prepare the person’s home environment

• Consideration needs to be given to environmental matters for the person following surgery:
• Light - this should be well distributed throughout the room, adjustable to the person's need, and without glare.
• Areas of possible danger or difficulty should be highlighted to make the person as aware of them as possible.  For example, stairs and steps should have their edges highlighted by tape or paint.
• Staff and other carers need to be careful not to leave open head-height cupboards, and be aware of other potential hazards, including ‘trip hazards’.

Consider the advice in What Can Help a Person with Monocular Vision?

Artificial eyes (prosthesis)

Referrals to an Orbital Prosthesis Department are made by the hospital consultant.  If an eye is removed, the person will probably be fitted with a ‘shell’ during surgery to maintain the socket shape.  A month or two after the operation, the person will be fitted with a temporary artificial eye, while a new artificial eye is specially made for them.  If the person is eligible for NHS treatment there is no charge for the provision of the eye.

The person will then need to be shown how to remove and clean the artificial eye (prosthesis) and the eye socket, or staff or carers will need to be shown how to do this.  The artificial eye fitter (orbital prosthetist) will show the person and carer how to do this, and explain how often it needs to be done.  The eye will need to have specialist cleaning once or twice a year at the clinic where it was fitted.

There is no risk of disease or infection from the secretions of the removed eye, although good hygiene is important for the eye socket.

The National Artificial Eye Service has an open access policy and will see all eligible patients.  It is as important for a person with a learning disability to look ‘normal’ and attractive.  In the past some people with a learning disability were not referred to this service because others wrongly assumed that their appearance did not matter.

Conclusion

For whatever reason someone may lose the sight in one eye there are likely to be some difficulties initially, relating to their ability to perform everyday tasks, move safely, interact with others, and feel emotionally well.  Given the right support the person can learn to adjust and hopefully in time they may feel positive about this change to their life.

Further information on vision in one eye only can be obtained from:
The National Artificial Eye Service
221 Bristol Avenue
Blackpool
FY2 0BF
England

Tel +44(0)1253 651131

Helpline Number is 0845 6050561 calls are charged at local rates within the UK.

Website:  http://www.naes.nhs.uk/

June 2009

For Further Information on this Topic please read:

Factsheet 1 – About Monocular Vision 

Factsheet 2 - What can Help a Person with Monocular Vision 

Consent to Medical Treatment

Eye Surgery for people with Learning Disabilities  

Recognising Eye Problems in People with Learning Disabilities 1

Recognising Eye Problems in People with Learning Disabilities 2