Pre-Operative Instructions

RISKS AND BENEFITS:

All surgery has risks and these risks include infection, bleeding, and scarring. Surgery in and around the eyes carries the unique risk of injury to the eyes, vision changes, and possible vision loss. This risk is quite low, but is real; just as there is real risk in many of the activities we carry out daily, such as driving or riding in a car. Additional risks include the possible need for enhancement surgery or revisions. When bilateral (both sides) surgery is performed, there is risk of asymmetry (difference between the two sides). Cosmetic dissatisfaction is another risk. Dry eyes are very common pre-operatively and may become worse after surgery. This is usually temporary, but it can be permanent. Other risks include: pain, irritation, and tearing; all of which are usually temporary.

The benefits of surgery around the eyes include rejuvenation of the periorbital tissues. This leads to improved function and, often, improved appearance. Improved visual fields (being able to see a broader area), diminished fatigue, improved tear function, and a refreshed appearance are some of the potential benefits, depending on the specific surgery you are having.

In the case of tumors or malignancies, benefits include definitive pathologic examination and characterization as well as removal of the involved tissue. Oftentimes this is the definitive treatment.

With reconstructive surgeries, the benefit comes from moving tissues into a position that allows them to function normally, or more normally, and provide protection for the eye(s).

BLOOD THINNERS:

Bleeding is a risk in all surgeries, therefore, it is common to stop blood thinners before surgery. In certain surgeries around the eyes, the risk of vision loss (though a very small risk) can be increased if a patient is taking blood thinners. Generally, blood thinners should be stopped for one week before surgery and one week after surgery, unless a physician prescribes the blood thinners. If a physician has prescribed or instructed you to take certain blood thinners, these should not be stopped until it has been cleared with your primary or prescribing physician. A list of potential blood thinners is included with this packet.

PRE-OPERATIVE INSTRUCTIONS:

Your surgery will be a “Same Day” surgery. Do NOT eat or drink anything after midnight on the night before your surgery. The only exception to this is that you may take your normal blood pressure medications with a small sip of water at the usual time. If your surgery is in our office and NOT at a surgical center, you do not need to fast.

Please shower/bathe the night before, or the morning of the surgery paying careful attention to gently cleaning the face and area around the eyes. Do NOT apply make-up, cologne, powder, or creams to the face or area around the eyes after cleansing. If you wear mascara or other eye make-up, please carefully remove this the night before surgery.

Do not wear hair clips, barrettes, earrings or any other jewelry (including rings, bracelets, watches, or necklaces) or any other metal materials. Wear a short sleeve shirt, or clothing that is easy to remove.

When you arrive at the surgery center you will be met by the pre-operative nurses who will start an I.V. and get you comfortably situated. You will then meet your anesthesia specialist. Most surgeries are done with I.V. sedation and local anesthetic injected into the operative site. Some surgeries require general anesthesia. Your anesthesia specialist will tell you what anesthesia will be best in terms of safety and comfort.

WHAT TO EXPECT:

Bruising and swelling is COMMON and NORMAL, and a significant amount will be present for 2-3 weeks in most cases. In fact, swelling often becomes gradually worse for the first two days after surgery. This is the reason you need to be vigilant with the cold compresses for the first 48 hours after surgery. PLEASE SEE YOUR POST-OPERATIVE HANDOUT FOR ALL POST-OPERATIVE INFORMATION AND INSTRUCTIONS AFTER SURGERY.

On average, 90% of the swelling and edema will resolve by 3 weeks after surgery. A small amount of residual edema may persist for several more weeks, though usually this is not noticeable. Using warm compresses after the first 48-72 hours will help dissipate this swelling and bruising.

Post-operative pain is VARIABLE depending on the procedure performed and the individual response to the procedure. Most patients are prescribed narcotic pain medications after surgery (usually Norco or Vicodin type medicine). It is common for patients to use some of that medication on the day of surgery and occasionally on the day after surgery. It is uncommon for patients to use narcotic pain medications beyond 2 days.

Visual acuity is commonly worsened and patients often state that their vision seems blurry. Most commonly, visual acuity is still good enough for activities such as driving, but patients may have difficulty reading finer print and such. This is most commonly due to tear film disturbance, swollen and tight tissues, and medications (drops and ointments) used after surgery. It may last anywhere from days to weeks.

Vision loss is VERY uncommon. However, if you notice loss of vision or diminished color vision, you must call your doctor immediately as this may represent an emergency.

“Grittiness” or dryness of the eyes is also common after surgery. The eye drops and/or ointment you are prescribed after surgery will help with this. After you begin to decrease or stop the prescribed medicines, you will likely use over-the-counter artificial tears to help with the dryness.

Sutures are often used in surgery and may be either dissolving or permanent. Permanent sutures typically need to be removed in the office approximately one week after surgery. This is usually painless and fast.

Infection is very uncommon with most oculoplastic surgeries. Mucus discharge around the eyelids with mattering (especially in the morning upon awakening) is normal as is redness, pain, and swelling. Signs and symptoms of infection include WORSENING redness, pain, or swelling, or purulent (pus) discharge or foul odor. If you have any of these symptoms you must call your doctor immediately.