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Eyelid, Lacrimal and Orbital Surgery

Eyelid, lacrimal and orbital surgery is cosmetic and reconstructive surgery to correct either the anatomy or function of those organs to make them as close to the normal as possible.

Before the surgery, the patient will be assessed for the problems and severity of injury by the oculoplastic specialist or surgeon so that the most appropriate surgery will then be recommended.

The importance of eyelid and lacrimal
Eyelid is a delicate organ. It serves as a wall to protect the eye. Any pathology occurs to eyelids could affect the eye such as irritation, inflammation, or infection. In the longer term such effects could even lead to permanent vision loss.

Lacrimal system releases tear produced by the lacrimal gland located beneath the upper eyelid. Tear serves to lubricate and remove wastes by leading them through the lacrimal drainage system into nasal cavity. Any pathology occurs to lacrimal affects to ability to release wasted tears. Surgery could bring back this function to normal and prevent lacrimal and eye infection in the future.
 
Eye socket related diseases that are frequently found include tumor which could occur either inside or outside the eye. The problem is always associated with its size and how much the eyeball is squeezed which affects patient’s vision; bulging eye caused by thyroid disease which in severe cases need eye socket expansion surgery; eye socket bone injury caused misshaped eye, etc. These cases sometimes necessitate orbital surgery for reconstructive purpose.
 
To correct either the anatomy or function of eyelid, lacrimal system and eye socket to make them as close to the normal as possible.
 
  1. Do not eat or drink anything (even water) eight hours before surgery (depends on the case by case basis). If you are taking medications, take them with only a small amount of water. If you have diabetes and need insulin injection, please ask your diabetes doctor the recommended unit of insulin on the morning of surgery day.
  2. Do not take aspirin, warfarin (Coumadin®), clopidogrel (Plavix®) or non-steroidal anti-inflammatory drugs (NSAIDs) such as brufen, diclofenac (Voltaren®) around 10 days before surgery.
  3. If there is no need to stay in the hospital, please have a relative to accompany you home (very important).
  4. Please wear comfortable clothes on the surgery day.
  5. Do not wear contact lens, make up, nail polish, or accessories on the surgery day. Please keep your valuable belongings at home.
  6. In case that antibiotic or penicillin is needed (either oral or drops), please use as prescribed by the doctor.
  7. Try lying on the back without a pillow, or low pillow. In some cases, facial drape might be used throughout the surgery which could be one hour or more.
  8. In the morning of surgery day, go to the operation room on the 5th floor or the Admission Center on the 2nd floor, Bumrungrad International Hospital building and inform our staff your name, hospital number, and present appointment card.
  1. After changing to surgical robe, wearing cap and slippers, you will be asked to wait on the operating table to check blood pressure and pulse by operating room staff.
  2. Intravenous fluid might be administered (depends on the case by case basis) on the arm. After speaking with the anesthesiologist, you will be sedated for stress relief.
  3. You will be brought to the operating room.
  4. Anesthesia will be administered around the eye so that you will not feel the pain during the procedure.
  5. After the procedure, you will be brought to the recovery area to rest before discharge.
  6. Your eye might be covered after the procedure.
  7. Post-procedure instructions and home medicine will be provided. The nurse will be explaining the instruction and medicines again to make sure everything is correct before discharge.
  8. Before discharge, you will get the appointment card.
  1. Diet: You can resume your normal diet.
  2. If you have a patch over your eye:
  • Non-absorbable stitches will be removed at the hospital.
  • Absorbable stitches will dissolve or fall out on their own.
  • Stitches: Stitches should be kelp clean. You can clean them gently with a moist Q-tip (Cotton bud) twice daily.
  • Never rub your eyes.
  • Avoid stooping, bending and straining for the first week after surgery.
  • If you have cough, take cough medicine.
  • If you are constipated, take a stool softener.
  • You may perform all normal activity as long as they do not involve jerking movements of the head.
  • Vigorous activity and exercise should be avoided for two weeks after surgery.
  • You may shower but try to avoid running water, soap, and shampoo over your eyes.
  • Hair may be shampooed “beauty shop” style with head back. DO NOT let “dirty” water run over eyes.
  • For the first week, it is preferable that you sleep with your head elevated on a couple of pillows. Try not to sleep face down.
  • Avoid makeup for at least two weeks or until the wound is healed.
Activities
  • You have been provided with an ice pack, which may be used on the way home and for the first 72 hours after surgery. Try to use it for twenty minutes on and twenty minutes off, but the more that ice is used, the less swelling, discoloration, and discomfort you will have. It is not necessary to use the ice pack while sleeping.
  • You may use crushed ice if possible or very small cubes. This will help the ice mold to the contours around the eyes. You must have a very moist gauze pad on the area prior to putting on the ice packs.
  • After 72 hours, warm, moist compresses are more effective in reducing swelling and discoloration.
  • If you do not have a patch over your eye, use your prescribed eye drops or ointment as directed after you get medications.
Cold compress:
  • Keep the patch on the eye at all the times. Do not start using any ointment until after your first appointment. You may take prescribed eye drops in your non-operative eye.
  • When one eye is patched, remember your depth perception will be poor. You may want to avoid any activities that require depth perception, i.e. driving.
  • Remove the patch in days and start using your prescribed eye drops or ointment.
  • Swelling: You can expect some swelling and black and blue discoloration. This may be more evident two or three days after surgery than after the first day. This swelling and discoloration may, by gravity, tend to collect in the lower eyelids or cheeks. The use of ice will help keep this to a minimum. These sensations should improve daily. If you have severe swelling or any of these symptoms persist or are worsening, contact your surgeon immediately.
  • Bleeding: Some oozing may occur from the incision site where the stitches are. This may need to be blotted occasionally. A light gauze may be applied to help stop the oozing.
    • If lacrimal surgery was performed, some oozing may occur from the nose and throat. A moustache dressing may be taped just beneath the nose to help with this.
    • No nose blowing.
    • If bleeding is severe or persistent, call your surgeon immediately.
  • Other symptoms include: more excessive tear, sensitive to light, itchy, blood red tear, taut eyelid. All these will be better by themselves each day. If they do not get better, please talk to your ophthalmologist immediately.
 
Call your doctor if you have any of the following:
  • A deep aching pain that is not relieved by Tylenol® or acetaminophen.
  • Sudden increased redness and/or purulent discharge (pus).
  • Increased blurring of your vision.
  • Bleeding that is excessive or does not stop.
  • Eye pain accompanied by nausea.
  • Flashing lights or a dark curtain coming down over the vision in your eye.
  • Before the procedure
    • Total stay in Thailand depends on the type of surgery you get.
    • It is recommended that you stay in the hotel nearby the hospital for convenient traveling to and from hospital.
  • After the procedure
    • You will have surgical site checked on the next day. The site or eye might be covered the first day after surgery (depend on the case by case basis). On the surgery day, a relative should accompany you to residence if there is no need for a hospital stay. If you need to stay in the hospital, a relative should accompany you as well.
    • In case of eyelid, lacrimal and orbital surgery, the ophthalmologist will make a follow-up appointment on the next day, and five to seven days after surgery. If there is nothing unusual, you will be allowed to travel back to your country depending upon the ophthalmologist’s discretion.
    • Basically, the ophthalmologist would make a follow-up appointment periodically, i.e. one day, one week, one month, three months, and six months after surgery. If it is not your convenience, you will be given a referral letter with details of diseases and treatments. You can present this letter to the ophthalmologist whom you are going to visit in your country for continual treatment.
Please note that eyelid, lacrimal and orbital surgery are delicate procedure. Success depends on types of disease, severity, complication, and surgical method.
 
What if the procedure is not performed?
Please discuss the risks, benefits, and what could happen with the ophthalmologist.
Please discuss treatment options with your ophthalmologist.

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