Preparing for Surgery with Prof Dinesh Selva

THE PRE-OPERATIVE VISIT:

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 remove any nail polish and if you have artificial nails please remove these from at least two fingers on your left hand.

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.

POST OPERATIVE INSTRUCTIONS FOR EYELID SURGERY:

• 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 rooms on 8211 0000 or Prof Selva on 0402 214 540 if after hours. 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, please contact Prof Selva on 0402 214 540 or your local doctor.