We conducted a population-based study of long-term trends in the incidence of enucleation. From 1956 through 1988, enucleation was performed on 99 residents (55 males and 44 females) of Olmsted County, Minnesota. The mean annual age-adjusted incidence per 100,000 population for males (5.17) was 50% greater than that for females (3.49; P = .04). An increase in the enucleation rate was noted with increasing age (P = .001), with the highest incidence in patients who were 70 to 79 years of age. A decrease in the incidence of enucleation over time (P = .002) was observed in Olmsted County residents who were at least 40 years of age and was caused primarily by the decreasing incidence of neovascular glaucoma and tumor-related enucleations. The incidence of traumatic enucleations did not significantly decrease (P = .25) over this three-decade study period.