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***Reader discretion is advised. If you are new to this blog, I recommend skipping to a slightly more palatable post, such as The Operating Room. ***

Eye Orbit Anatomy

The eye in the orbit

In the operating room, my attending lifted the drape from the patient’s eye and said, “Ugh!”

It was a dead eye in a living man: the cornea obscured with dark storm-clouds, the sclera yellow and decaying. It had not seen light in many decades.

I stepped forward, looked down at the eye, and shrugged my shoulders. The attending surgeon grinned as he leaned toward the resident, whispering loudly: “It doesn’t bother her.”

For the first enucleation (eye removal) of the day, I tried to stop the bleeding from the central retinal artery, but my index finger was too small – or rather, “petite,” as my attending described it. Blood overflowed from the depths of the eye socket and spilled onto the patient’s ear. My attending graciously took over. (“Not that you aren’t doing a good job,” he said reassuringly.)

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For the second enucleation procedure of the day (on a different patient), I held the scissors in my hand while my attending lifted the otherwise severed eyeball. With a deep breath, I snipped the optic nerve and surrounding vessels before inserting both my index and middle fingers into the orbit. It was a strange, otherworldly sensation: arm held steady in midair, fingers deep in a stranger’s skull, my bones protesting the tight quarters with jagged edges.

“Do you feel the arterial pulsations?” the attending asked me.

I nodded. “You know in the newborn nursery, where you let a baby suck on your finger to help them stop crying? It feels sort of like that.”

I held pressure for three long minutes. When the attending asked me to remove my fingers, I did so with some difficulty. Both the attending and resident were silent for a brief moment as they stared inside the empty orbit. The bleeding had stopped entirely.

“Well, I haven’t seen that in a while!” said the attending, grinning widely behind his surgical mask.

While the operating room staff seemed impressed at how well the bleeding had stopped, I was even more relieved about something else. For the first time in several weeks, since I watched a patient die on a different rotation, I had looked blood in the eye (no pun intended), shrugged my shoulders at its ubiquity, and conquered it. Even when the eye was yellow and lifeless, invoking memories of that other patient’s gaze as I pounded into his chest, my primary emotion during this procedure was neither panic nor grief. It was wonder.

The thrill of the operating room is something to behold.

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