Abstract
The history of the management of blind, painful, and traumatized eyes and anophthalmia began with the oldest civilizations in the world and unfolded along with the history of humanity. Physicians in ancient times recognized the devastation and disfigurement that came with the loss of an eye. Various decorations and prostheses were made to cover the unwanted deformity and to help individuals maintain their social status in the community. As early as the 1500s, surgeons were relentlessly exploring new techniques to safely remove the globe and preserve an acceptable postoperative appearance. The progress made included a better understanding of orbital anatomy, the use of orbital implants and conformers, and the development of aesthetically appealing ocular prostheses. With the advent of anesthetic gases and antibiotics, surgeons routinely began performing eye removal operations, often to prevent the contralateral eye from developing sympathetic ophthalmia after trauma. Different surgical techniques to remove the whole globe (enucleation) and to remove only the intraocular contents (evisceration) were explored. A controversy over the selection of enucleation versus evisceration began and has been debated for more than a century. Because of the risk of sympathetic ophthalmia and inadvertent orbital spreading of intraocular melanomas following evisceration, this procedure was nearly abandoned by the early 1900s but has recently become much more widely used. Glass artificial eyes (ocular prostheses) were developed in Germany but became scarce after the beginning of World War II, when commercial trade with Germany was halted. Ocularists in the United States and the United Kingdom subsequently found alternative prosthetic materials, including acrylic, and techniques, such as socket impressions, to improve the fabrication of artificial eyes. The fundamental steps in modern-day eye removal surgery are not much different from those performed a hundred years ago. This chapter briefly summarizes the story of eye removal and management of anophthalmia throughout human history.