Outpatient Eyelid Surgery

How to prepare for eyelid surgery?

See your primary care physician or internist 3-4 weeks prior to your surgery for standard preoperative clearance. You may have blood drawn and and you may need an EKG. If you live out of the area you may have this done near your home.

Avoid medications which thin your blood per your surgeon’s instructions. These include aspirin, ibuprofen, Aleve, Motrin, Excedrin and Coumadin. Also avoid vitamins E & C and herbal supplements such as Gingko Biloba and St. John’s Wart. Patients who are taking daily doses of aspirin, Coumadin, or other blood thinners may need to see their cardiologist, in addition to seeing their internist or regular primary doctor, to be cleared for surgery. These medications may be resumed shortly after surgery. Blood thinners include Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban, and Eliquis (apixaban).

You may need to schedule a preoperative visit in with the surgeon. This is separate from your initial consultation and not the same as a surgery clearance with your internist or primary care physician. If you live out of the area, your preoperative visit may be scheduled a day or two before your procedure provided you were cleared for surgery by your local physician.

There is usually a preoperative visit at the surgery center, where you will meet the business office staff, who will make sure all financial information is up to date, and will get you registered.

You will also meet the anesthesiologist and perhaps a nurse anesthetist. The anesthesiologist plays an active and important role in assessing and preparing people with complex medical conditions for surgery. Either before or on the day of surgery, an anesthesiologist reviews available medical information, completes an examination, and discusses the anesthetic plan with the person who is undergoing the operation and his or her family. The anesthesiologist can answer any questions or concerns at this time.

At this visit, the doctor may also require the following information:

  • Copies of medical records, especially ECGs and results of heart and lung testing and recent lab tests.
  • A list of medical problems and past surgical procedures, including any problems that occurred during prior surgeries.
  • A complete list of medications (both prescription and over-the-counter), including vitamins, herbs, or other supplements, and their dosages.
  • A clearly identified list of medications that cause allergic reactions or other problems.

The evaluation before surgery seeks to address questions, to help calm fears and anxiety regarding anesthesia and surgery, and to ensure that a person understands his or her existing medical problems. This evaluation also confirms that the person is in the best condition prior to surgery.

Sometimes, medication changes or additions are recommended or more testing is required before surgery. Rarely, an anesthesiologist may delay or cancel the surgery for further evaluation.

Make arrangements for someone to take you to and from your surgery, and someone needs to stay with you for at least the first 12 – 24 hours. You may not drive home from surgery. Most patients can drive 24 – 36 hours after surgery.

It is smart to prepare for your after-surgery care by stocking up on the following items:

  • Crushed ice cubes, zip lock bags, and paper towels (to make ice packs).
  • Clean wash cloths.
  • Sterile gauze pads.
  • Tylenol, Advil, or Alleve tablets.
  • A bottle of artificial tears.

It is also smart to pre-shop for groceries for the first several days after your surgery. Pre-cooking meals that you can freeze and then reheat with a microwave oven is an excellent means of reducing the effort needed for cooking after surgery. Plan to not perform housework, chores, or other tasks for several days after surgery.

What to do on the day of surgery?

On the day of surgery, be sure and shower or bathe, and cleanse your eyebrows, eyelids, and face gently with antibacterial soap. Remove all makeup, including false eyelashes, etc. Do not wear contact lenses.

Do NOT eat or drink anything after midnight the evening before the day of your surgery. Food or drink in your stomach can lead to nausea or vomiting. If this happens during the procedure, it can lead to extremely serious complication.

You will be given instructions on what medications to take the day of surgery. If you are to take meds, do so with a sip of water, just enough to swallow the pills.

Wear loose fitting clothing, wear no jewelry except wedding rings. There is no need to remove false teeth, partials, or hearing aids.

At the Surgery Center

Most outpatient centers ask that the individual undergoing surgery arrives 1-2 hours before surgery to allow time for the following: checking in, placing the IV, and administering antibiotics or other medications. These activities usually occur in a preoperative waiting area, where the anesthesiologist and possibly nurse anesthetists (nurses trained to participate in anesthesia care) may be present.

The individual is then escorted from the preoperative area to the operating room, which is usually chilly. The operating table (or bed) is well padded, but it is not nearly as comfortable as a bed at home. Anesthesia monitors are placed at this time, including heart monitors on the chest, a blood pressure cuff on the arm to monitor blood pressure, and a soft rubber clip on the finger to monitor oxygen level. Extra oxygen is given by a nasal tube while the individual is in the operating room.

The anesthesia team begins sedating the individual and perhaps starts an additional IV line. Depending on the procedure, the individual may be given general anesthesia, local anesthesia, regional anesthesia, or spinal or epidural anesthesia.

General anesthesia, given through an IV, or as inhaled as gas allows the individual to be completely unconscious during the surgery.

Most people receive local anesthesia after they receive additional medications for sedation during the procedure. With local anesthesia, doctors inject local anesthetics (numbing medication) directly around the operative area once the sedation medications allow the patient to enter a twilight sleep. This technique allows the surgical procedure to be done comfortably and with little or no pain at all.

For the procedure, the individual is positioned on his or her back.

Throughout the surgery, the anesthesia team closely monitors the individual to ensure his or her safety and comfort. Medication is given to the person not only to provide anesthesia but also to control the heart rate and blood pressure.

With the completion of surgery, the anesthesia team brings the individual to a recovery room where he or she continues to awaken fully from the sedation. Recovery usually takes about an hour.

Ideally, the individual wakes up with minimal to no pain or discomfort. If significant pain is experienced, a nurse should be informed immediately. The recovery nurse monitors and treats the individual if other problems arise, such as nausea, vomiting, chills, and low or high blood pressure. An anesthesiologist is also available to assist in the recovery room.

Going Home

All outpatient centers have strict discharge criteria. The individual should be able to meet the following criteria before being released:

  • Have stable vital signs (heart rate, blood pressure, breathing rate, temperature, and pain level).
  • Tolerate food and drink (Tolerating food and drink is important because oral medications may need to be taken to relieve pain or to prevent infection.).
  • Be able to empty bladder.
  • Walk unassisted.

A responsible adult must be present at the time of discharge to assist the individual in going home. In addition, this adult should be with the individual at all times for the first 24 hours to provide help when necessary and to call for help should a problem arise.

Before going home, the person should have written instructions on the following:

  • Whom to contact in the hospital if a problem or complication occurs.
  • What medication to take for pain.
  • Activity level, and when a return to work is possible.
  • When to start eating.
  • Where to go if evaluation or admission to a hospital is necessary.

What to avoid during the recovery period?

Refrain from doing any activity that has the potential to raise your blood pressure such as exercising, bending, lifting, brisk walking and sexual activity. Do not drink alcoholic beverages. Do not take medicines or supplements which thin the blood. The doctor will inform you when it is safe to resume these activities.

It is fine to read, watch TV, work on a laptop/tablet/computer, play quiet games, do crossword puzzles, sew/knit/crochet, etc., after surgery. You want to avoid any sort of effort as mentioned above.

What to do to minimize bruising and swelling?

Sleep in an upright/reclining (not flat) position for about 1 week following surgery to minimize the collection of fluids in the face and eyelids.

Using ice packs or cold moist compresses will help to reduce the severity of bruising and swelling as well. Using them hourly for the first day or two makes a significant impact on bruising. After the first few days, ice packs may be alternated with warm packs to help circulation remove the bruising and swelling more rapidly.

You may consider using arnica montana, (one brand name is Sin-Ecch), an herb that has been shown to decrease bruising after surgery. In eyelid surgery, studies show that it is really only 50% helpful in reducing bruising, but if used it is not harmful if you follow instructions carefully.

Be sure to understand and follow the instructions you will be given after surgery. Know how to administer your cold and warm compresses. These will not only reduce bruising and swelling but will maximize and promote healing.

When will stitches be removed?

If absorbable stitches are used, they will dissolve in about 7 – 14 days. If nonabsorbable stitches are used, they are removed in about one week, or when the wound is adequately healed.

When will the first follow up appointment be scheduled?

Usually about 7 days following surgery. The doctor will determine this on the day of your procedure. You will be given an appointment for your first post operative visit along with detailed instructions which you must follow carefully. Any other follow up appointments will be determined based on how the tissues heal.

Special Cases: Children

For parents or caregivers, surgery performed on their children is much more stressful than if they were having surgery performed on themselves. In these instances, speaking to the anesthesiologist regarding the anesthetic plan is even more important. Children benefit significantly from surgery in the outpatient setting because it decreases separation from their family and the home.

A parent or other responsible adult must accompany all children.

Many surgery centers sedate a child in the waiting room or preoperative room to help with anxiety.

A parent may not enter the operating room with the child. Many parent think that for the first part of anesthesia, coming in with the child would help to comfort the child in this strange environment. However, this is not true in the vast majority of cases. It is better for the child to be under the care of the health team, who have experience in this situation, which makes the process much safer for the child.

Children often inhale anesthetic gases as they go to sleep. Every child is different. Some go to sleep quietly, and others cry and try to fight the anesthesia.

Once the child is asleep, doctors insert an IV and begin the surgical procedure.

Children often wake up from anesthesia and cry or struggle. This is an unfortunate circumstance that occurs as a result of the child being disoriented from the anesthesia. Most children become quiet and more alert very soon after they enter the recovery room. The parent or adult is reunited with the child early in the recovery period to provide comfort and added security-for both of them. Children must also meet discharge criteria before they can be sent home.

Problems

Outpatient surgery is very safe, with a low frequency of complications. However, potential risks and complications are associated with any surgical procedure, no matter how minor. Some risks are related to the surgery, and other risks are related to the anesthesia. The most frequent complications include nausea and vomiting, sore throat, and discomfort at the surgical site.

Although more serious complications are rare, heart attack, stroke, excessive bleeding, and even death have occurred in the outpatient setting. Some people may require hospital admission following surgery. The doctor should be alerted as soon as possible if a problem is suspected after a person is discharged from the outpatient center. The earlier the doctor is aware of a potential problem, the sooner appropriate treatment can be started to avert any long-term effects.