WHAT CAUSES A WATERY EYE?

A watery eye can be due to many causes. It is essentially an imbalance between the amount of tears being produced by the tear gland and amount that can be removed by evaporation and the tear drainage system. Problems with the eyelid or narrowing of the drainage canals can prevent tears being drained into the nose. Some people have more than one factor causing their watering. Even some people with dry eyes may also experience watering due to reflex tearing as the eye attempts to keep itself moist.

WHAT IS A BLOCKED TEAR DUCT?

Tears are produced continuously and are drawn into a small hole in the inner corner of your eyelid known as a punctum. There is one in the upper and lower eyelid. They lead into small tubes known as the canaliculi, which in turn drain into the lacrimal or tear sac. This lies between the corner of your eye and your nose and has a duct at the bottom, which drains into your nose, the nasolacrimal duct. If the nasolacrimal duct blocks the eye becomes watery, and sometimes sticky. Some people develop a painless swelling of the tear sac at the inner corner of the eye and a few get repeated painful infections, like a boil or abscess.

Why does blocked tear duct occur?

The normal system does not have much spare capacity (that is why we “cry”) and the narrow drainage channel becomes even narrower with age, especially if there has been nose or sinus disease.

HOW DO I KNOW IF I NEED AN OPERATION?

Your doctor will examine you to see if your watering is due to a problem in the tear drainage system. This will include syringing water through the tear ducts to see whether there is a blockage. Sometimes an x-ray examination of the tear drainage pathway (a dacryocystogram and/or dacryoscintillogram) is needed to help determine the cause of your watery eye.

WHAT DOES THE SURGERY INVOLVE?

The surgery creates a new pathway between the tear sac and the inside of the nose by removing a small piece of bone between them and bypassing the blocked nasolacrimal duct. This operation is called a dacryocystorhinostomy or DCR for short.

The surgery is done through an endonasal approach avoiding a skin incision and is performed through the nose using an endoscope. If the nasal passage is too narrow a procedure to straighten the nasal septum (septoplasty) may also be done.

In a few patients small soft silicon tubes are placed in the tear canals to keep the passages open while healing takes place.

HOW SUCCESSFUL IS THE SURGERY?

In most cases where the obstruction of the tear duct is in the nose, there is a 90% success rate. This means 1 in 10 people may not improve after surgery.

Rarely if the obstruction is in the tiny tear canals on the eyelid, the success rate is less and can vary between 50-90% depending on the extent of blockage.

WHAT TYPE OF ANAESTHETIC IS NECESSARY AND DO I NEED TO STAY IN HOSPITAL?

The operation takes about 30 minutes and is usually performed under a general anaesthetic where you are asleep, or under local anaesthetic with intravenous sedation to make you sleepy so you do not feel any discomfort.

You will usually have the surgery as a day patient and go home the same day. Although the great majority of patients will have surgery as a day patient, some may elect to stay in hospital overnight. This will usually be for social reasons such as if you live alone. Professor Selva will discuss this with you as necessary at the consultation prior to surgery.
If you do stay overnight then you will be discharged the next morning by the nursing staff if you have no problems. You do not need to see Professor Selva.
It is advisable to be driven home by a friend or relative and not to travel home on public transport. You must not drive yourself.

WHAT SHOULD I DO IN PREPARATION FOR SURGERY?

Blood thinning medications such as aspirin, clopidrogel (Plavix, Iscover) and warfarin can make bleeding more likely during and after surgery. If you are taking these drugs your doctor will tell you if and when to stop these medications prior to surgery. You should also stop anti-inflammatory drugs like ibuprofen (Nurofen), fish oil, ginger, ginseng and garlic containing supplements 2 weeks before surgery.

If you smoke you should stop smoking for at least 3 days prior and 1 week after surgery. This is important as smoking impairs wound healing and increases the risk of infection.

Avoid alcohol for a day before and a day after surgery.

You will need to fast – no FOOD from midnight and then CLEAR fluids only (water/cordial or black tea/coffee – no milk,) up to two hours before admission.

On the day of surgery please dress casually and wear a top which buttons at the front.

Do not wear any makeup, jewellery or contact lenses.

IS THERE ANYTHING I SHOULD NOT DO AFTER THE OPERATION?

After your operation, have a quiet evening and avoid strenuous exercise, running or heavy lifting (>5kg) for a week. You cannot drive, operate machinery, drink alcohol or take sedative drugs for 24 hours. You can wash and shower normally but avoid a very hot shower/bath in the first week. Do not swim for two weeks.

Do not blow your nose for 2 weeks as this may cause bleeding. You may wipe your nose or gently sniff to clear it. If you sneeze, try to keep your mouth open.

Very hot food and drink should be avoided for 1 week after the operation as they can increase the risk of bleeding.

WHAT HAPPENS AFTER SURGERY?

After the operation you will have some bright blood/pinkish discharge ooze from the nose. This usually stops within a few days. If there is bleeding sit forward and apply an ice pack to the bridge of your nose for 15 minutes by the clock without releasing. You may also suck on an ice cube as this may help reduce the bleeding. Wipe away any bleeding with a clean tissue/towel. Spit out any blood into a bowl on your lap. Repeat for another 15 minutes. If the bleeding is severe or continues for more than half an hour, call Prof Selva or attend your nearest accident and emergency department.

There is usually no significant pain after the surgery. You may note some aching, tenderness, swelling and bruising on the side of the nose and around the eye. If you experience pain take panadol or panadeine (not aspirin or ibuprofen for two weeks as this could cause bleeding). Take 2 tablets every 4 hours as necessary (maximum of 8 in a day).

If you wear glasses you may find that it is a little tender where the glasses rest on the nose and you may need to rest your glasses a little further down the nose for a couple of weeks.

Your nose will feel blocked for about a week, however, remember you are not allowed to blow your nose. You will be given a saline nasal spray which you should spray up the nostril on the side of the surgery twice a day for 2 weeks. You can start this 24 hours after surgery. This helps to wash away any old blood and discharge from the nose. If you have been given antibiotics to take after the surgery then please complete the course as directed.

You may drive after 24 hours and most people require a week off work.

Do not travel on an airplane for 2 weeks after surgery.

Do not be discouraged if your eye is still watery after surgery. It is usual to have a watery eye for some weeks or even months after surgery until the swelling and inflammation has settled.

When you do start to blow your nose after 2 weeks you may notice a slight puff of air over the eye. This occurs in many patients after successful surgery and is a sign that the new drainage passage is open.

If you have had tubes inserted at the time of surgery, they are often just visible in the corner of the eye between the two eyelids. The tubes will be removed at your appointment 6-12 weeks after surgery. They are tied inside the nose and a loop can occasionally protrude from the inner corner of the eyelids. If this happens do not be alarmed: if you are able to gently push the tubes in again then do so. Otherwise make an appointment to be seen at the clinic so they can be repositioned or removed. If the loop is large it can be taped to the side of the nose or onto the cheek until you see the doctor so it does not prevent blinking.

WHAT ARE THE MAIN COMPLICATIONS FOLLOWING A DCR?

Bleeding: A nose-bleed can occur up to 14 days after surgery. This happens to about 1 in 100 patients. In most cases the bleeding will stop by itself or with icepacks, but if it continues or is very heavy you should call the Adelaide Skin & Eye Centre. If after hours please call Prof Selva or attend the accident and emergency department at your nearest hospital.

Infection: Infection of the wound or sinuses may rarely occur in 1 in a 100 people usually within the first week and is treated with oral antibiotics. If you develop a temperature or increased nasal or facial pain then seek medical advice.

Failure of the watery eye to improve: This occurs in 1 in 10 people and can sometimes be improved with a second operation.

If a septoplasty is done, rare complications include a small hole (perforation) in the septum which can give rise to crusting and bleeding. Other rare complications include nasal deformity, infection, cerebrospinal fluid leakage and alteration of sense of smell.

WHAT IS THE FOLLOW-UP TREATMENT?

You will be given an appointment with Professor Selva for 4-6 weeks after surgery to check if the new drainage pathway is open.

If you require any further information or advice about your operation, please call:
Adelaide Skin & Eye Centre 8211 0000 (Monday to Friday 9am to 5pm)

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Ptosis is the medical name for drooping of the upper lid, which can be present in one or both eyes. A low upper lid can interfere with vision, by affecting the top part of the visual field and may also be a cosmetic problem.

Patients might have difficulty keeping their eyelids open, eyestrain or fatigue.

Ptosis can either be present at birth (congenital), or may present later in life (acquired) usually as a result of stretching of the muscle over time. It may also occur with long-term contact lens wear, trauma, after cataract surgery or other eye operations. There are also less common causes of a droopy eyelid, such as problems with the nerves or muscles.

HOW IS PTOSIS TREATED:

Ptosis can be corrected in most cases with a quick operation that takes between 30-60 minutes. This surgery is done as a day procedure so you do not have to stay in overnight.

You will have a “freezing injection” (local anaesthetic) and some mild sedation so you do not experience any discomfort. The surgery is also sometimes done with local anesthetic alone in which case you will feel some stinging for a few seconds as the “freezing injections” are given but the eyelids then become numb and you will not feel any discomfort. If you have sedation, it will make you sleepy for the beginning of the surgery so you will not feel any injections. During the surgery you will be awake so that the surgeon can ask you to open and close the eyes to help place the lids in the right position.

Ptosis surgery usually involves re-attaching or shortening the muscle that raises the lid. This is done using sutures, which are buried under the skin. The surgery is done through an incision in the eyelid crease so the scar will not visible once healed. Any excess skin in the upper eyelid may also be removed at the same time. There will be some stitches along the upper eyelid fold which will be removed at one week.

If both eyes have ptosis it is usually best to operate on both sides at the same time to give the best chance of a symmetrical result.

WHAT SHOULD I DO IN PREPARATION FOR SURGERY:

Blood thinning medications such as aspirin, clopidrogel (Plavix, Iscover) and warfarin can make bleeding more likely during and after surgery. If you are taking these drugs your doctor will tell you if and when to stop these medications prior to surgery. You should also stop anti-inflammatory drugs like ibuprofen (Nurofen), fish oil, ginger, ginseng and garlic containing supplements 2 weeks before surgery.

If you smoke it is strongly recommended that you stop smoking for at least 3 days prior and 1 week after surgery. This is important as smoking impairs wound healing and increases the risk of infection.

Avoid alcohol for a day before and a day after surgery.
You are required to have nothing to eat or drink for at least six hours before surgery.

On the day of surgery please dress casually and wear a top which buttons at the front. Please wash your face on the morning of surgery and men should shave.

Do not wear any makeup, jewellery or contact lenses.

WHAT HAPPENS AFTER THE OPERATION:

The eyes will usually be left uncovered. Sometimes a dressing will be placed over the eyes: if both eyes have been done then one eye will be uncovered after an hour, prior to going home. Any remaining eye pad should be removed the next day.

Once you are home you should rest for the next 24 hours. You can then do most of your normal activities but avoid any vigorous activity, running, gym work or heavy lifting (>5kg) for 2 weeks.
If you have had sedation, do not drive, operate machinery, take alcohol or sedative drugs for 24 hours.
It is advisable to keep the operated area relatively dry for 7 days although showering is permitted after 48 hours.

The eyelids and cheeks will become very swollen and bruised (“black eyes”). This is normal and may get worse in the first 24-48 hours before it starts to get better. Icepacks (or frozen peas wrapped in a hand towel) can be used to help reduce the swelling. Hold the icepacks over the closed eyes for 10 minutes and repeat hourly for the first 3 days. The bruising and swelling often takes 2-3 weeks to settle.

There is usually no significant pain and most patients find panadol or panadeine is all that is needed for any discomfort. Take 2 tablets every 4 hours as necessary (maximum of 8 in a day).

Do not be worried if the lids look too low or too high or have an odd shape in the first week while they are swollen as this usually improves over a few weeks.

Your vision may be slightly blurred in the first couple of weeks while the lids are swollen: this will improve once the swelling settles.

You may also find that the eyes feel gritty and dry in the first few weeks as the eyes are more open than before. If the eyes are already slightly dry before surgery, they might be worse after the operation. This will usually disappear when blinking becomes easier as the swelling settles. Artificial tear drops or ointment may help during this period.

Some patients also note that the eyelids above the eyelashes are a little numb for a couple of months until the nerves recover.

Please purchase Poly Visc or similar (non medicated eye ointment) from your local chemist a few days prior to your procedure to apply along the suture line twice a day for 7 days. 1⁄2 cm or 1⁄4 inch is sufficient

You will usually need about one week off work.

Do not swim, wear your contact lenses or eye make-up for 2 weeks, and longer if the eye remains red. Avoid sun exposure by wearing a hat or dark glasses for up to six months.

WHAT ARE THE MAIN COMPLICATIONS FOLLOWING PTOSIS SURGERY:

About 95% of patients are corrected satisfactorily with one operation. Approximately 5% (1 in 20 people) may require further touch up surgery.

As the eyelids will often be low for a few weeks due to swelling your surgeon will generally wait for at least 6 weeks to see the final lid position. If the eyelid is a little too low or high or the curve of the eyelid is irregular at this time it can be corrected with a second procedure.

If you experience bleeding from the wound use an ice pack wrapped in a towel to apply firm pressure to the eye for 15 minutes (by the clock and without releasing) and then repeat if the bleeding continues. Almost all cases of bleeding will settle with pressure. If it does not then call the Adelaide Skin & Eye Centre during clinic hours. If after hours, please call Prof Selva or attend your nearest hospital emergency department.

Infection is rare and may occur as increased pain, tenderness, swelling and redness around the stitches. This is generally easily treated with a course of antibiotics.

Rarely, months or years after successful surgery, drooping of the eyelid may occur again. This can be corrected with further surgery.

WHAT IS THE FOLLOW-UP TREATMENT:

You will be given a clinic appointment for one week after surgery with a second appointment some weeks later when the swelling in the lid should have gone down and a more accurate assessment of outcome of surgery can be made. Stitches are usually removed at about one week after surgery.

If you require any further information or advice about your operation, please call:
Monday to Friday 09.00 to 17.00 call: Adelaide Skin & Eye Centre 8211 0000

The post PTOSIS Patient Information appeared first on Adelaide Skin and Eye Centre.

This consultation allows us the opportunity to meet with you, obtain your medical history and determine the most suitable way of treating your eyelid, tear duct or orbital condition. It also gives you the opportunity to learn about the proposed procedure and ask us any questions.

The costs associated with your surgery will be discussed with you during this visit. Please note that we are an Accredited Day Surgery and if you have Private Hospital Cover there will usually no gaps for the relevant Theatre Fees (unless you have an excess on your policy) but there may be gaps associated with the operation or anaesthetist.

WILL I BE ADMITTED TO HOSPITAL:

One of the advantages of eyelid surgery with Professor Selva is that wherever possible, it is performed as an inpatient procedure in our Day Surgery. However, depending on the procedure, admission to the Memorial Hospital is sometimes required-if this is considered necessary; we will discuss this with you at the preoperative visit.

GETTING READY FOR SURGERY:

Our staff will call you 24 – 48 hours before the time of your surgery to confirm your appointment

Try to get a good night’s rest, follow the fasting regime explained on the admission form and take your regular medications (unless otherwise instructed). It is a good idea to wash your hair the night before or the morning of the day of your surgery. Please do not wear makeup & wear comfortable clothes which will not have to be pulled over your head after the operation. Please wear a loose long sleeve shirt or a short sleeve shirt so the anaesthetists can access your arm if required. Please remove any nail polish and if you have artificial nails please remove these from at least two fingers on your left hand. Please remove all false eye-lashes prior to surgery.

BEFORE SURGERY:

Please inform us if you take medications which increase bleeding e.g. Aspirin, Clopidogrel (Plavix, Iscover) or Warfarin as we may need to stop them or reduce dosage prior to surgery. Anti-inflammatory medications (e.g. Nurofen), Garlic Oil or Fish Oil capsules increase bleeding, so please stop 14 days before surgery.
Please take Paracetamol and codeine preparations if you require pain relief in this pre-operative period.

Please inform us if you are allergic to latex.

Alcohol also aggravates bleeding so please avoid alcoholic drinks for 24 hours prior to and after surgery. Smoking reduces blood flow to the skin and slows healing. It would be helpful if you could stop smoking for a minimum of 3 days prior to surgery and for one week afterwards.

You can expect to be at the Day Surgery for 3-4 hours. The procedure itself will probably take an hour to an hour and a half and then you will be in the Recovery area for about an hour and a half. It is a good idea to bring a book or magazine with you on the day of surgery.

Please arrange for someone to take you home as legally you may not drive for 24 hours following the anaesthetic and it is required that you arrange for someone to be with you the night of your surgery.

If you have not already done so, please complete and return your Patient Admission Form as soon as possible to confirm your admission for day surgery and also to confirm your financial responsibilities prior to your admission.

If you live in the country, we may suggest staying in Adelaide for 1-2 days or longer post surgery as we may wish to check your wound before you return home.

THE DAY OF SURGERY:

We will issue you with a Car Parking Permit (ASEC patients only, not Memorial) to enable the person accompanying you to park in the area under the Day Surgery reserved for this purpose. Simply complete the date and time of surgery on the form and leave on the dash of the car.
When you arrive for surgery, you will be taken to the waiting area and the nurse will prepare you by:

1. Confirming your medical history and drug therapy from the form you have filled in.
2. Taking your temperature, pulse and blood pressure, weighing you and checking other observations.

Once you have been seen by the anaesthetist we will take you in to the operating theatre and make you comfortable on the bed. The anaesthetist will put a small bung in the back of your hand and will give you some sedation through this which will let you drift off to sleep. While you are asleep Professor Selva will inject some local anaesthetic around the area for surgery – you will not feel this as you will be asleep.

The sedation gradually wears off and you will be able to talk with the staff. You will be aware that you are having surgery but you will not feel anything.
At the completion of the surgery your eye may be covered with a dressing (we will give you written instructions about when to remove the dressing).

You will then return to the recovery room where you will be allowed to rest quietly until you are able to go home accompanied by a friend or relative.
The Day Surgery provides tea, coffee and biscuits. If you would like to bring something else to eat following your surgery you are welcome to do this.

Please have someone on call to collect you within an hours notice.

POST OPERATIVE INSTRUCTIONS FOR EYELID SURGERY:

We will explain exactly how you should care for your wound before you leave, and give you an appointment for follow up care and suture removal.

We will explain exactly how you should care for your wound before you leave, and give you an appointment for follow up care and suture removal; the suture removal appointment will be with the nurses. If there are complications you will have a follow up appointment with Professor Selva

• Wash your hands prior to removing your eye pad in________________________________________
• Leave your eye pad intact until you return to Professor Selva’s rooms for a dressing.
• Monitor your IV site and report any redness, pain or signs of infection to Adelaide Surgicentre.
• POST OP APPOINTMENT: Date:________________________________Time:___________________________

ACTIVITIES:

• Please rest quietly all day following surgery. You do not have to remain in bed and you may watch TV and read. You can resume normal daily activities the next day.
• Have a responsible adult with you for the first 24 hours following discharge (only for sedation patients).
• You should resume taking your normal medications.
• Most patients usually take at least a week off work.

DO NOT:

• Do not perform any exercise, swimming, strenuous activity or lift more than 5 kilograms for the first week.
• Do not take a shower or a bath for the first day. (Use a sponge bath if needed)
• Do not drive or travel alone on public transport until 24 hours after surgery and until the eye dressings are removed.
• Do not sign legal documents, make important business decisions or use hazardous machinery until 24 hours after surgery.
• Do not drink alcohol until 24 hours after surgery.
• Do not apply makeup around the eye for 2 weeks.
• Do not put your contact lenses in for 2 weeks.

INSTRUCTIONS FOR EYE DRESSING:

You will usually have a dressing over your eye. If the patch becomes loose, apply more tape. You may remove the pad only if directed on your postoperative instructions. While the patch is on do not get it wet. Once you have removed the patch, you may shower and wash your hair. Avoid getting too much soapy water in or around your eyes and the operated area.

COLD COMPRESSES:

Please apply cold compresses over the wound for comfort and to reduces welling:

1. A small bag of frozen peas or similar wrapped in a clean cotton cloth is a good cold compress. If using ice cubes, place in a leak-proof plastic bag. Alternatively, specially designed masks are available from chemists.
2. Use a clean washcloth or small towel to wrap the compress. Do not apply the ice mask directly to your eyes.
3. Sitting upright, close the eyelids and then apply the compress.
4. Use cold compresses for 15 minutes every hour during waking hours.
5. Continue cold compresses for 3-5 days after surgery – OR UNTIL SWELLING SUBSIDES.
6. If using a commercial eye mask, place the eye mask in the refrigerator for an hour, or for an extra soothing effect, put in the freezer for 10-15 minutes. Do not allow mask to freeze solid.

WHAT TO EXPECT AFTER EYELID SURGERY:

• You will have significant swelling and bruising (black and blue) which is usually worst after a day or two. This is quite normal. The discolouration may extend to your chin. This is normal and will soon fade.
• Eyelid surgery sometimes damages nerves and you may experience a sensation of numbness around the wound. This will usually return slowly to normal over a period of 6 to 12 months, though occasionally the numbness may be permanent. Any form of skin surgery will leave a scar.
• You may have mild oozing from the incision.
• If your eye or wound will not stop bleeding, apply a cold compress and very firm pressure without releasing to the bleeding site for 15 minutes. If bleeding persists, please repeat cold compress for a further 15 minutes. If bleeding continues, PHONE the practice during business hours or call 8211 0000, and the after hours voicemail message will provide you with the appropriate contact details. If Prof Selva is unavailable please contact your local doctor or go to your nearest emergency department.
• You will probably experience pain for a few days after surgery. You may also experience a sensation of grittiness in the eye(s). You can take the pain medication as prescribed to control the discomfort.
• Report any severe pain to Professor Selva as above.
• You may have some slight blurring of vision due to discharge and the ointment.
• The stitches will usually be removed at your follow-up appointment at 1 week.

POST-OP MEDICATIONS:

• Please purchase Poly Visc or similar (non medicated eye ointment) from your local chemist a few days prior to your procedure to apply along the suture line twice a day for 7 days. 1⁄2 cm or 1⁄4 inch is sufficient.
• Pain relief medication can be taken for mild discomfort or ache. In general, Panadol or Panamax (one or two 500mg tablets every 4 hours. Maximum of 8 tablets in 24 hours) is sufficient. If you have been prescribed stronger pain relief, please take as directed.
• If you have been prescribed oral antibiotics, please take as directed.

OTHER

If you had IV sedation as part of your procedure, please contact us on 8211 0000 if the IV site becomes red, swollen or painful or if you notice symptoms of a fever (feeling, hot, cold or shivery) up to 48 hours after the procedure. If after hours, the after hours voicemail message will provide you with the appropriate contact details for Prof Selva or contact your local doctor.

The post Preparing for Surgery with Prof Dinesh Selva appeared first on Adelaide Skin and Eye Centre.

Ectropion is the medical term used to describe an outward turning of the lower eyelid.

The majority of ectropion are due to laxity of the tissues of the eyelid as a result of the ageing process. As we get older the eyelid stretches and becomes floppy allowing it to turn out.

Another reason this may happen is as a result of sun damage to the cheek skin causing it to contract and pull the eyelid down. This condition is known as a cicatricial (scarring) ectropion and is very common in Australia due to the large amount of sun exposure we experience.

WHAT ARE THE SYMPTOMS?

Ectropion can lead to excessive tearing, redness, mucous discharge and irritation of the eye. There is also a chance of damage to the surface of the eye.

WHAT IS THE TREATMENT FOR ECTROPION?

An operation is usually needed to fix an ectropion. The surgery lasts between 45 to 60 minutes and is performed with “freezing injections” (local anesthesia) with or without sedation as a day case procedure. If you have sedation, it will make you sleepy at the beginning of the operation so you will not feel any discomfort with the local anaesthetic injections. The surgery is also sometimes done with local anesthetic alone in which case you will feel some stinging for a few seconds as the “freezing injections” are given but the eyelids then become numb and you will not feel any discomfort.

This operation will involve tightening of the lower lid, which will correct the lid laxity. You may have a small incision of 10-15mm with a few stitches at the outer corner of the eye or extending down from the edge of the eyelid.

A small skin graft may be needed if there is sun damage to the lower lid skin. The graft is usually taken from in front of the ear, the upper eyelid or near the collar bone and you will then have some stitches in these areas. Professor Selva will inform you if it is likely you will need a graft when your surgery is booked.

Sometimes a watery eye may persist after successful ectropion surgery as the tear ducts may not be functioning and this may be corrected with further surgery if necessary.

WHAT SHOULD I DO IN PREPARATION FOR SURGERY?

Blood thinning medications such as aspirin, clopidrogel (Plavix, Iscover) and warfarin can make bleeding more likely during and after surgery. If you are taking these drugs your doctor will tell you if and when to stop these medications prior to surgery. You should also stop anti-inflammatory drugs like ibuprofen (Nurofen), fish oil, ginger, ginseng and garlic containing supplements 2 weeks before surgery.

If you smoke it is strongly recommended that you stop smoking for at least 3 days prior and 1 week after surgery. This is important as smoking impairs wound healing and increases the risk of infection.

Avoid alcohol for a day before and a day after surgery.
You are required to have nothing to eat or drink for at least six hours before surgery.

On the day of surgery please dress casually and wear a top which buttons at the front. Please wash your face on the morning of surgery and men should shave.

Do not wear any makeup, jewellery or contact lenses.

WHAT HAPPENS AFTER THE OPERATION?

The eye will be padded after surgery and you can then return home to rest. You will be instructed when to remove the dressing over the eye. If no skin graft has been used the eye pad is usually removed the next day. If a skin graft is present then the dressing may need to remain in place for a few days. Keep any dressings dry till they are removed. Although the great majority of patients will have surgery as a day patient, some may elect to stay in hospital overnight. This will usually be for social reasons such as if you live alone. Professor Selva will discuss this with you as necessary at the consultation prior to surgery.

If you do stay overnight then you will be discharged the next morning by the nursing staff if you have no problems. You do not need to see Professor Selva.

Once you are home you should rest for the next 24 hours. You can then do most of your normal activities but avoid any vigorous activity, running, gym work or heavy lifting (>5kg) for 2 weeks.

If you have had sedation then you cannot drive, operate machinery, take sedative drugs or alcohol for 24 hours. Do not drive while the eye is covered with a dressing.

Please purchase Poly Visc or similar (non medicated eye ointment) from your local chemist a few days prior to your procedure to apply along the suture line twice a day for 7 days. 1⁄2 cm or 1⁄4 inch is sufficient. The eye may feel irritated or scratchy on the inside or the outer corner of the lower eyelid. The eye may also produce yellow-green discharge in the first week as a reaction to the surgery.

The eyelids and cheek will become very swollen and bruised (“black eyes”) and the eye may look “bloodshot” once the dressing is removed. This is normal and may get worse in the first 24-48 hours before it starts to get better. Icepacks (or frozen peas wrapped in a hand towel) can be used to help reduce the swelling. Hold the icepacks over the closed eyes for 10 minutes and repeat hourly for the first 3 days. The bruising and swelling often takes 2-3 weeks to settle.

There is usually no significant pain and most patients find panadol or panadeine is all that is needed for any discomfort. Take 2 tablets every 4 hours as necessary (maximum of 8 in a day).

If you have had a skin graft this may change to a dark colour; this is to be expected and will slowly improve with time. A skin graft can take a couple of months to blend into the surrounding skin. There may be some temporary numbness in the surrounding skin. Your vision may be slightly blurred in the first couple of weeks while the lids are swollen: this will improve once the swelling settles.

It is advisable to keep the operated area relatively dry for 7 days although showering is permitted once the dressings are removed.

Do not swim, wear your contact lenses or eye make-up for 2 weeks, and longer if the eye remains red. Avoid sun exposure by wearing a hat or dark glasses for up to six months.

You will usually need about one week off work.

WHAT IS THE FOLLOW-UP TREATMENT?

You will be given a clinic appointment for one week after surgery when the skin stitches will be removed by one of our nurses.

If a skin graft has been used then we may organise to see you in 2-3 days to remove the dressing. If you are from the country, we may organize for removal by your GP if possible. An appointment will be made for 1-2 months after surgery to see Professor Selva for a final check of the lid position

WHAT ARE THE MAIN COMPLICATIONS FOLLOWING ECTROPION SURGERY?

Ectropion surgery is generally very successful with 95% of patients corrected with one operation. A few people may require a second procedure some months later if the initial surgery fails to correct the lid position. The ectropion may also rarely occur again over the years usually due continued scarring of the eyelid skin due to sun damage. The surgery can be done again to fix this.

Wound healing issues such as the wounds splitting or coming apart are uncommon and can be managed by either letting the wound heal in by itself or by stitching the wound.

If you experience bleeding from the wound or eye use an ice pack (or frozen peas are a good alternative) wrapped in a towel to apply firm pressure (without releasing) to the eye for 15 minutes by the clock and then repeat if the bleeding continues. Almost all cases of bleeding will settle with pressure. If it does not then call the Adelaide Skin & Eye Centre during clinic hours. If after hours please call Professor Selva or attend your nearest hospital emergency department.

Infection is rare and is associated with a marked increase in pain, tenderness, swelling and redness. Most infections can be easily treated with a course of antibiotics.

Very rarely an internal stitch may rub against the surface of the eye causing an intense scratching pain every time the eye is moved. If this fails to settle, put some of the antibiotic eye ointment in the eye and contact the eye clinic to be seen within a day.

If you require any further information or advice about your operation, please call:
Monday to Friday 09.00 to 17.00 call: Adelaide Skin & Eye Centre 8211 0000

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