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Patient information – care plan for eyelid or orbital surgery
 

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Before the operation

 
Avoid aspirin or ibuprofen-type medication (non-steroidal anti-inflammatory medication) for approximately two weeks before surgery, as this can increase any tendency to bruise. If you take aspirin regularly for medical reasons, please consult Mr Malhotra about whether it is safe to discontinue use.
 
It is advisable to stop smoking at least three weeks before surgery and not to smoke until at least two weeks after wounds are fully healed. Nicotine closes the blood vessels responsible for bringing oxygenated blood – vital for healing – to the tissues. Oxygen also fights infection and helps to keep tissue alive, as well as being instrumental in delivering important medications, such as antibiotics. Smoking clogs the lungs and therefore increases risk of pulmonary infections, such as pneumonia.
 
On the day of surgery
  • Dress casually
  • Wear slip-on shoes and a top that buttons down the front
  • Do not wear jewellery
  • Thoroughly wash your face
  • Don't wear make-up
  • No contact lenses
  • Discuss your oral medications with Mr Malhotra – they can usually be taken with a sip of water
 
If your operation is scheduled for the morning:
  • Do not eat or drink anything after 12 midnight the previous night – do not have breakfast.
 
If your operation is scheduled for the afternoon:
  • Have an early, light breakfast – do not eat or drink anything after 7.30am.
 

After surgery

 
Eyelid swelling and bruising may seem to be worse the day after surgery and the discolouration may run down your face from your cheeks to your chin. Both are normal and will soon fade.
 
What should I do after surgery?
 
  • Make sure you are being picked up after surgery and there is someone with you for 24 hours.
  • Please rest quietly all day following surgery. Avoid bending or excessive exercise for the first two days following surgery or as advised.
  • Maintain an elevated head position and use two or three pillows at night for the first 3 days.
  • Always wash your hands before and after treating your eye.
  • You may have a pad on your eye. If so, then do not remove it until advised.
  • If the pad becomes loose, apply more tape but do not remove the pad.
  • While the pad is on, do not get it wet. Shower from the neck down or take a bath.
  • When you remove your eye pad, peel the tape downwards.
  • Once you have removed the eyepad, you may shower and wash your hair.
  • Apply a cold compress immediately after patch is removed, and then several times per day. (See instructions below.)
  • Apply your eye ointment as instructed by your doctor (thinly, inside the lid from the inner corner outwards).
  • You may need to take your usual painkillers for 48 hours after surgery. Take your anti-inflammatory and antibiotic medicine as prescribed.
  • If your eye is sticky or has discharge around the suture line (stitches), bathe it using cooled boiled water. Close your eye and wipe gently from the inner corner to the outer corner, ensuring you use a fresh piece of cotton wool for each wipe.
  • Observe your eye for severe swelling and telephone the ward if it is getting worse or you are concerned.
  • Remember to actively blink your eye shut (so that it completely closes) every 5-10 seconds for the first week after surgery. It is common for blink-closure to be weaker immediately following surgery. 
  • Dos and don’ts
  • You can watch television or read directly after surgery, but remember your vision may be blurry.
  • Do not have hot drinks or hot food immediately after surgery, if you can, wait until the following day.
  • If your surgery was under general anaesthesia, do not have dairy products for the first 24 hours, as these may make you feel nauseous.
  • Do not take a shower or a bath for the first day.
  • Do not get soap into the incisions for the first week.
  • Do not drive on the day of surgery. Wait until you can see a registration plate clearly at 20m and the effects of any sedation have resolved. This is a legal requirement.
  • Do not wear contact lenses for the first 2 weeks. This is to keep the risk of wound infection low.
  • Do not do any heavy work, lifting, running, gym work-outs or swimming for four weeks
  • Do not run out of your medication.
  • Please do not miss your clinic appointment as your stitches might be removed at this appointment. Should the time of appointment become unsuitable please call to rearrange.
  • If you had tear duct surgery (dacryocystorhinostmy – DCR) or orbital surgery, do not blow your nose for 1 week. 
  • Steristrips and sutures
  • If you have small white Band-Aids (Steristrips) on your wounds, leave these for five days. You can remove these, by just peeling them off. If they are difficult to remove, soak them in warm water for a few minutes first. If these fall off earlier, do not worry and please do not replace them.
 
Some stitches can be removed by yourself after six days. If you have received these instructions after your surgery, you will see a thin blue stitch after you have peeled off your Band-Aid (Steristrip). You can hold one end of this stitch and just pull it out after seven days. This type of material is designed to slide out easily, there will be no pain and there is nothing you can do wrong.
 
How do I apply a compress?
 
Cold
 
Using the eye mask provided:
  • Place the eye mask in the refrigerator for an hour or for an extra-soothing effect, put it in the freezer for 10-15 minutes.
  • Do not allow the mask to freeze solid.
  • Use the eye mask provided according to instructions only. Never apply the eye mask directly to your eyes. Wrap it on a clean moist washcloth, small towel, piece of moist cotton or lint if you don't have any of these, a pad of moist tissues or paper towels will do.
  • Apply the wrapped eye mask to the operated eye(s) – keep the eye(s) closed.
  • The eye mask should be applied before using the eye ointment.
  • It is not necessary to use anything sterile to apply a compress.
  • The eye mask is filled with a non-toxic gel in a non-PVC casing. If the contents come into contact with your eyes you should wash them with cold water immediately. If there is any irritation or redness, contact Mr Malhotra or the hospital.
  • Use the eye mask 6-8 times a day – as often as you can tolerate.
  • Keep the mask on for 10-15 minutes each time. 
Alternatively:
  • Put ice or crushed ice wrapped into a plastic bag and wrap with a moist flannel (not dry). If it is too cold leave it for 5 minutes before applying it to your eyelid so that you don’t give yourself frostbite. 
  • After 1 week switch to warm compresses to closed eyelids.
This is not essential but may help speed up resolution of established swelling.
 
Using the eye mask warm
 
  • Soak the eye mask in water that is hot to the touch for 5-10 minutes.
  • Check the mask isn't too hot or too cold by pressing it against the back of your hand before you apply the mask to your face.
  • Apply the wrapped eye mask to the operated eye(s) – keep the eye(s) closed.
  • Use 4 times a day – as often as you can tolerate.
  • Keep the mask on for 10 minutes each time. 
  • Observe any swelling and report if it is getting worse.
  • Observe for discharges around the suture line and bathe eyelids.
  • Apply the ointment according to Mr Malhotra's instructions.
  • Sleep on at least two to three pillows, if possible, to keep your head elevated. 
  • Alternatively:
  • Soak a clean flannel in hot water and squeeze out excess water. Make sure it is not too hot. Apply the flannel for a few minutes, keeping the eye(s) closed.
  • Observe any swelling and discontinue warm compresses if it is getting worse. 


IMPORTANT

 
Please call the hospital if you are experiencing any of the following:
  • Severe, increasing pain, redness and swelling of the wound area
  • Decrease of vision
  • Fever
  • Active bleeding
  • Skin rash
 

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