This is a page of general information and advice. You will get personal counseling regarding the specifics of your own surgery. Move directly to the subject of interest to you:
Two weeks before surgery
If safe to do so, stop regular aspirin/ clopidgrel to minimise the risk of bleeding. If in doubt ask your surgeon to discuss this with your GP prior to stopping the medication.
Avoid using ibuprofen or other non-steroidal anti inflammatory agents (NSAIDS). Avoid food supplements such as garlic, gingko, ginger, vitamin E which tend to increase the risk of bleeding.
It is generally recommended that these medications are stopped as in the eyelid or tear duct the surgical field is very small and often the desired correction is measured in millimetres (in lid surgery), so significant bruising and bleeding can have a significant impact on the surgical outcome.
Day of surgery
Your consultant should go through the consent procedure and you will have your opportunity to ask your final questions and sign the consent form. Often pre-operative photographs may be taken if this has not already been taken at the prior consultation.
You will be taken to the operating theatre. If you are having the operation under local anaesthetic, the injection in the eyelid area is generally the most unpleasant part with stinging. Afterwards you may feel sensations of pressure but there should be no pain. If you experience significant discomfort please let your surgeon know so your local anaesthetic can be topped up.
If you are having your operation under a general anaesthetic or sedation, you will first be seen by your anaesthetist and when you arrive in the operating theatre he/ she will insert a needle into a vein in the back of your hand. After this you should not experience much discomfort from any further anaesthetic or surgery.
One or both eyes may be bandaged. These bandages stay on for about 6 hours or overnight in most cases and if you are having the surgery as a day case procedure you may remove the bandages the next morning at home. If you are having a bilateral procedure then one or both bandages are removed before you leave the hospital.
Day 1 after surgery
How to reduce swelling and bruising
1. Once the eye pad has been removed, start ice pack treatment as soon as possible.
2. Sit upright as much as possible during the day and sleep with your head on 2 – 3 pillows for the first few days after surgery.
Ice pack treatment
1. Specially designed masks are available from chemists – you would need to purchase two or three so that there is always one cooled.
2. Alternatively, a small bag of frozen peas or ice cubes in a non-leaking clear clean plastic bag (e.g sandwich bags which can be bought from a supermarket) which is then wrapped in a clean cotton cloth will make a good icepack.
3. Sitting upright, put some clean gauze over the eyelids then apply the icepack. This can be cold and you need to hold a cloth in your hand or wrapped around your head in order to secure the icepack.
4. Try icepack application for 30 minutes every hour during waking hours if possible, but if you cannot manage this, anything longer than 15 minutes every hour is satisfactory.
5. Continue icepack applications for 3 days after surgery.
Wash your hands first!
1. The first eyelid clean is done when the eye pad is removed (first dressing) or approximately 8 hours after the surgery.
2. Use sterile gauze squares and saline solution. Either purchase Normasol ® sachets of saline or make up a simple solution with one teaspoon salt in a half pint water which has been boiled. Leave to cool before use and make up a new set before each use.
3. Soak the gauze swabs in the saline and place on the eyelids to remove superficial debris.
4. Dab the eyelids, moving the gauze across the eyelid and avoiding the eye.
5. After the first cleaning, clean twice daily for the first week then daily for the second week.
Avoid soaking the wound in the bath or in a swimming pool for at least 2 weeks. You can wash or shower as usual. Do not wear your contact lenses for at least 2 weeks. You will be reviewed in clinic 1-2 weeks after the surgery. A second appointment will be made at approximately 6 to 8 weeks to allow a more accurate assessment of the lid height.
How to put in your eye drops
1. Please wash your hands before putting in your eye drops.
2. After upper eyelid surgery, gently pull down your lower lid and look up, then put the drop into the gap between the lower lid and the eye. Do not touch the eye with the eyedropper.
3. After lower eyelid surgery, it is best to put in your eye drops by gently pulling the upper lid up and looking down. Then put the drop onto the eye. Be careful not to put excess pressure on the lower lid.
Day 3 after surgery
Swelling and bruising is now usually at its maximum. I generally describe the swelling situation as if you have gone a few rounds in the boxing ring with a pro. The the eyelid skin is very thin and very prone to swell impressively. Mild painkillers may be required. Continue ice packs if soothing. Restart aspirin/ clopidogrel if previously stopped.
Days 7-14 after surgery
See your consultant to remove the sutures between 7-14 days. The swelling should be subsiding and the bruising starting to fade. Generally 90% of the bruising settles in 90% of patients within 14 -21 days and makeup may be applied as the skin wounds should be healed. It should be fine to return to work, resume a normal social calendar and undertake mild exercise.
1. If “absorbable sutures” have been used these may not require removing.
2. Sometimes, even when “absorbable sutures” were used, the surgeon will decide to remove these between 4 and 21 days after surgery.
3. If “permanent” or “non-absorbable” sutures are used, these are removed between 4 and usually 10 days after surgery. Rarely, if a graft has been taken from the ear or scalp, the sutures are left infor 2 weeks. N.B If a stitch breaks and the wound opens, or the vision blurs, or there is bleeding, discharge or excessive pain, please contact your surgeon.
6 -8 weeks after surgery
The remaining 10% of bruising and swelling should have settled in most people. See your consultant for review. You should now look good enough for the post-operative photos.