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When it comes to eye problems, we often tend to think of areas like the lens, cornea and retina.
But some common eye complaints are caused by issues outside the eyeball – conditions such as droopy eyelids, in-turning or out-turning eyelids, eyelid lumps and tumours, problems with tear ducts and issues involving the eye socket. This is where oculoplastics can help. Oculoplastic surgeons are specialised ophthalmologists (eye doctors) who perform a range of eyelid and facial plastic operations to treat and improve conditions around the eyes.
Frequently asked questions
What will happen during my eyelid surgery?
This is very common in the first two weeks after the operation due to swings in the eye pressure, minor bleeding inside the eye and inflammation. These typically settle within the first few weeks. A small minority of patients (around five to eight percent) may have some degree of permanently reduced vision after the operation. As with all intraocular surgery, loss of all vision in the eye due to the surgery itself is possible, but it’s very unusual.
DISCOMFORT: Any discomfort from the procedure usually settles within a few weeks, but some patients do experience long-term discomfort. However, the symptoms are usually mild and can be controlled with artificial tears.
INCREASED LIKELIHOOD OF CATARACTS: This is quite common within five years of the operation. If cataracts do occur, they can be treated in the normal way. In some patients, a trabeculectomy works less well if a cataract operation is performed subsequently.
INFECTION AND LOSS OF VISION IN THE EYE: There is a small risk of infection after any form of eye surgery, including trabeculectomy. With trabeculectomy there is also a permanently-increased risk of infection getting inside the eye. But the risk is small: roughly one in every 100 operations.
Further surgery may be required to ensure that the operation is successful, or to correct low pressure. It’s not unusual for an additional procedure of some sort to be required, but this is usually a much shorter procedure than the trabeculectomy itself.
How long does an eyelid operation take?
Most unilateral (single-eye) procedures usually take about 30 minutes. Bilateral (both eyes) operations can take 45-60 minutes. After the surgery we will clean and wipe your face. In some cases we may apply an eye pad, which will stay in place for between 24 and 48 hours. In most cases, however, an eye pad isn’t necessary. Immediately after the operation, we often advise patients to apply an icepack to the eye for 20 minutes, to minimise any post-operative bruising. You can do this as soon as you get into the recovery area — the nurses will have a pack ready for you to use when you get there. In the recovery area, the nurses will also explain how you can best manage your eyes in the post-operative period. Once all this has happened, you’ll be free to go home.
How long will it take my eyes to recover after surgery?
Every patient responds to surgery in different ways and heals at different speeds. As a rule of thumb, though, you can expect some swelling and bruising in the first week after eyelid surgery, which will be visible to other people. In the second week, this begins to settle and it’s usually not very apparent that surgery has taken place. Any scars from the operation are designed to blend into the normal creases of the skin around your eyelids.
We see all our patients a week after their surgery so that we can review the healing process and remove any sutures. We will see you again for a final check after about two to three months. For patients who work, we usually recommend taking at least one week off to recuperate after surgery. Some people prefer to allow a fortnight, but we can review this when you come in for your post-operative appointment at the end of the first week.
What can I do to help my recovery?
The effects of the local anaesthetic usually begin to wear off after an hour. In practice, most patients rarely experience much discomfort after the operation. But if your eyes do feel painful, it’s fine to take some paracetamol (assuming you don’t have an allergy to this medication). Eyelids have an excellent blood supply. This is good because it means they heal very quickly, but by the same token they can also become bruised and swollen following surgery. The amount of bruising and swelling you experience can be quite variable and difficult to predict. But there are some things you can do to help reduce them.
Using ice and gentle pressure on the eyelids after surgery can help to reduce the swelling. The simplest way to do this is with a bag of frozen peas wrapped in a tea towel. Press this gently onto your closed eyelids for 20 minutes. You can repeat this at regular intervals, ideally five to six times a day for the first three days.
Eyelid swelling can be affected by the position of your head relative to your body during the healing process. Keeping your head up and above the rest of your body during the first few days may help to ease some pressure on the lids. Sleeping with a few extra pillows, or putting a few books under the head of your bed, can keep your head a little higher when you are asleep and reduce any extra swelling overnight.
It’s important to give your body time to heal and recover, so we always recommend that you avoid any strenuous activity for at least two weeks following your surgery. Light exercise such as walking is fine, but try to avoid anything that raises the heart rate too much or involves putting your head below your body. You should avoid swimming for the first two weeks as well. You can wash your face and take showers, but try to avoid getting the eyelids too wet.
Studies have shown that smoking affects the healing process after eyelid surgery, which is why we ask patients to stop smoking in advance of their procedure. If you do smoke, we recommend you avoid it for at least two weeks before your operation takes place, and for the first few weeks afterwards.