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Eyelid malpositions

Entropion = eyelid turning inwards

Ectropion = eyelid turning outwards

Ptosis = drooping upper eyelid

The position of the eyelids may be affected by various factors. Simple ageing of the lid tissues may cause them to droop or to turn inwards or outwards. The lid position may also be affected by laxity of the tissue caused by repeated lid rubbing over the years or by other causes such as scarring or inflammation of the surrounding tissues. Long term contact lens use can cause drooping of the upper eyelid and the lower eyelid may droop due to a weakness of the surrounding facial muscles. The cause of your lid position will be discussed with you in the clinic before your surgery as will the best treatment for you.

Information for patients undergoing lid surgery (lid shortening, lid lifting/lowering, excision of lesions)

Most surgery is carried out under local anaesthetic and performed as a day case. You may be asked to return a day or two after surgery for a post-operative check.

What can I expect on the day of surgery?

You will have some drops put into the eye which may sting for a few seconds and which will numb the surface of the eye. The local anaesthetic is given using an injection into the lid. This will also sting for a few seconds but once the stinging has gone, you should not feel anything else.

The surgeon will then clean the area using a sterilising iodine solution. Your head will then be draped to help keep the area sterile.

The surgeon will then start the surgery and will usually use an operating light to make things clearer which will be bright to start with but which you will get used to.

You may feel sensations of pressure but you should not feel any pain. If you do feel anything please let the surgeon know because more local anaesthetic can be given.

During the surgery you may hear various beeps and buzzing noises from the machines which are used. At the end of the surgery, some ointment may be put into the eye and a pad put on the eye. The surgeon will tell you when you should remove it and may give you a prescription for some drops to put into the eye once you have taken off the pad.

What should I do if I am taking aspirin or warfarin?

Aspirin and warfarin increase the tendency to bleed during surgery and to bruise. Please let the doctor know prior to your surgery if you are taking either of these. If you take aspirin regularly, it is better to stop taking it two weeks prior to surgery. Please discuss this with your eye doctor if you have any doubts. Warfarin should only be stopped under the advice of your doctor.

How long will it take for the lid to heal completely?

Usually the wound will have healed in a week or two. The lid may be bruised for this length of time. If you have had an operation to correct the position of the lids it may take a few months before the final result is achieved.

What are the complications?

The lids may be bruised and swollen. This will settle over the first days and weeks. Very rarely in the first 24 hours after lid surgery bleeding into the eye socket may occur. This is painful and may be associated with severe visual loss. If you develop a severe pain in the eye after lid surgery please contact the on-call eye doctor immediately. Wound infection is a possible complication which can lead to wound breakdown but it is uncommon.

Am I likely to require further lid surgery?

It is possible that you will require more than one operation to achieve a satisfactory result. Occasionally the lid heals in such a way that the lid position or appearance is unsatisfactory after your operation and this is when further surgery is required.

Care of the lid after surgery

When you take the eye pad off, you may find some dried blood and mucus in and around the eye. The lids may be bruised and swollen. If you have had an upper lid operation, the lower lid may also look bruised. The vision may be slightly blurred due to the ointment and mucus in the eye. The swelling may actually get worse on day 2 after surgery before it starts to subside.

Very gently clean away any excess blood from around the eye and the wound. Do not clean the wound itself because it will almost certainly break down. (The stitches that are most commonly used dissolve in water over a period of a few weeks and cleaning them in water will make them dissolve quicker). Be very careful not to put any pressure on the wound because that too may increase the chance of wound break down.

You will probably be asked to return to clinic a week after surgery when you may have your stitches removed.

You may be given a prescription for antibiotic drops and ointment. Please use these as instructed.


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