An enucleation is most classically contraindicated after the onset of sympathetic ophthalmia (Nunery 1990), and in cases of virulent endophthalmitis (Nunery 1990, Meltzer 1987). However, with improved diagnosis and technique, and considering the relative rareness of sympathetic ophthalmia (Meltzer 1987), there is some debate as to whether these diseases necessarily contraindicate an enucleation. An enucleation is also contraindicated in cases where it can be expected that the patient will experience increased psychological trauma from the thought of losing the “entire eye”. In the latter case, an evisceration is indicated. Finally, an enucleation is relatively contraindicated in cases where excessive hemorrhaging is expected.
An evisceration is contraindicated in cases where an intraorbital neoplasm is suspected, in cases where acute trauma may prevent complete removal of the uveal tissue, and in cases where a complete histological exam is needed.
A secondary implant is contraindicated in cases where there are no complications with the primary implant and where cosmesis and artificial eye motility is satisfactory. It should be noted that with the development of the Bio-eye HA orbital implant many patients now consider their existing motility and the appearance of their (drooping) lids to be unsatisfactory. The patient’s desire for a more natural-looking artificial eye can be extremely strong. Therefore, it is important that the surgeon offer informed counsel regarding the probable results of a secondary implantation using the Bio-eye HA orbital implant. Further, the candidacy of each patient should be evaluated on an individual basis. The best results are realized when both the patient and the surgeon are fully informed about the capabilities of this implant.