FAQ - Oculoplastics

Medicare have set very strict criteria as of November 2018 for this procedure to be covered. Essentially one must suffer from a visual field defect, confirmed on visual field testing as well as meeting a criteria for eyelid skin overhang as evidenced by clinical photographs. Some inflammatory problems such as thyroid eye disease or floppy eyelid syndrome may qualify without meeting these standards. If you do not qualify, you can still have surgery in hospital however would need to cover the hospital, surgeon and anaesthetists costs out of pocket, or the procedure can be done in rooms under local anaesthetic only, at a lower cost.

Dr Slattery performs Blepharoplasty surgery either in an operating theatre under sedation with local anaesthetic, or in rooms with local anaesthetic only. Any excess skin, muscle or fat is removed via an incision hidden within the natural upper skin crease. Blepharoplasty is often combined with lifting of the eyelid (Ptosis repair), Eyebrow Lift or other procedures.

You will often be placed in the near sitting position with eyepads and ice packs for 1 hour. You will then be able to go home. You can expect minor ooze from wounds for 24 hours and significant bruising and swelling for around 2 weeks. We encourage ice packs 30 minutes at least 4 times a day and to minimise exertion.

This procedure is a day procedure. If required you can stay in hospital overnight.

You will be seen at the one week mark for suture removal and wound check if this is required. You will then be seen at the 2-3 month mark as it may take this long for the eyelid to completely recover. Dr Slattery or the staff at Western Eyecare are available any time however should you have any queries or concerns.

Your vision will be blurry for around 2 weeks because of a transient change in refraction, dryness and dispersion of ointment used. Regardless, you should be able to drive and use a computer the day after surgery. Pain generally is not an issue, but you can take Paracetamol or Ibuprofen if required.

On occasions, an offending inflammatory process or eyedrop may be contributing to the eyelid malposition and treatment may restore the lid position. Most of the time a procedure correcting excess laxity of eyelid tendons, and strengthening of lengthened stabalising muscles of the eyelid need to be performed. This may be combined with a full thickness skin graft or mucosal graft if there is insufficient skin or conjunctiva to allow the restoration of eyelid position.

This procedure is usually day surgery. If the procedure has been combined with a skin or mucosal graft then an eye pad is usually required to stay on the eye at least 3 days.

You will require ice packs for 1 hour over the affected eye. We recommend ice packs 30 minutes 4 times per day for the first week, but only twice per day if a graft is used. This procedure can lead to discomfort and a sandy feeling in the eye for up to one week. There may be minor discharge and blurring of vision which often resolves after a week or so. Bruising and swelling around the eye is to be expected and can be quite significant. Tenderness at the outer part of the eye associated with a lump is also to be expected and is intended.

For those who are not required to wear a pad, most activities can be continued the next day if comfortable. If you want to have a shower try to stay out of direct water flow and use some antibiotic ointment to the wounds prior. If you have a pressure pad then try to keep dry until removal.

Levator based surgery can be performed via a discreet incision in the upper lid crease or via the posterior eyelid in which there is no visible scar. Regardless of which approach, the muscle is shortened and reattached to the eyelid essentially raising the baseline position of the eyelid.

A sling procedure is performed also through inconspicuous incisions in the eyelid and forehead. Sling material may be synthetic (often slilicone) or using fascia from the outer part of the leg. Each has its own pros and cons and will be discussed at the time of consultation.

When performed on children this is generally performed under general anaesthetic but in adolescents or adults is usually performed under local anaesthetic with sedation so that the eyelid height can be tailored appropriately. The procedure generally takes 30-40 minutes per eye.

Wet eyepads and ice packs are applied for 1 hour immediately post operatively. You will need someone to pick you up and take you home. Pain is generally minimal and simple analgesia such as Paracetamol usually sufficient. Dry eye is a common problem for several weeks after the procedure and lubricating drops may be required in the short term, but are rarely required longer than this.

Eyelid skin is very thin meaning significant swelling and bruising are common. This generally lasts 7-10 days. A mild ooze from the wound is not uncommon for a day or two. There is usually low grade swelling for longer but this is not noticeable to the observer. Asymmetry of eyelid height or contour may occur and can be corrected if necessary. Importantly, the eyelid can be lifted or dropped again if required. Infection is rare and often patients will be given antibiotics at the time of surgery. Dry eye is very common and usually subsides after a few weeks but lubricating drops are often helpful in the early period. Once the swelling settles down, lid function and blink will improve also.

This is generally performed as a day procedure. Expect to spend half a day in hospital.

Ice 30 minutes four times a day to the closed eyelid. This is often therapeutic also. An antibiotic ointment applied to the wounds three times per day for 2 weeks. At the four week mark we ask that the wounds be massaged with either a vitamin E, Bio-oil or Rosehip oil for two months thereafter.

Often the next day. Pain is generally not an issue but most patients will have mild blurred vision for a few weeks because of the antibiotic ointment, swelling, dryness and a subtle change in refraction of the eye. As long as you are comfortable with that vision, most non-strenuous activities can be continued. Please refrain from any strenuous activities and swimming for 2 weeks.

Minimise direct contact of water on wounds in the shower for the first three days. From there on use ointment to the wounds prior to having a shower in addition to three times per day.

Congenital tear duct obstructions are common but usually spontaneously resolve by 12 months of age. Of those that persist beyond 12 months, almost all will persist. A simple probing will often relieve the obstruction if performed prior to 2 years of age. The success of this procedure declines with advancing age. This procedure is effective in 90% of cases. Of cases that fail, a second probing with insertion of silicone stents will often have a success rate of 90%.

For congenital cases that have failed probing and stents, as well as acquired tear duct obstruction, the treatment commonly involves dacryocystorhinostomy (DCR) surgery. In this procedure a conduit is created between the tear sac and the nose thus bypassing the blocked tear duct so tears can drain straight into the nose.

Rarely a blockage in the proximal mucosal lined passages between the eyelid and the tear sac occurs and a DCR may be combined with insertion of a lester jones tube between the medial part of the eye and the nose. This bypass tube connects the tear lake and nose.

This procedure can be performed externally or endonasally via a camera within the nose.

An external approach requires a tear trough skin incision which is usually around 8-10mm long. The benefits of this approach is a succsess rate greater than 95% with minimal manipulation of nasal tissue. This approach can be performed under general or local anaesthetic with sedation and can be performed on patients unable to stop blood thinners.

An endonasal approach is beneficial because there is no visible scar. Also any endonasal issues such as a deviated septum or sinus disease can be addressed at same by an ENT surgeon. The success rate is not quite as high but in experienced hands is nearing the external approach. This approach however always requires a general anaesthetic and is not suitable for patients on any blood thinners.

Blood nose: Minor bleeding is common and usually spontaneously resolves over a 1 week course. This may be longer and heavier in those taking aspirin or anticoagulants. Any heavy bleeding that is persistent should be notified to your surgeon.

Scar: An external approach leaves a small scar which is often imperceptible after a few months but on occasion can cause some webbing of skin on the lateral nose. Scarring of intranasal structures can occur with either approach.

Cerebrosinal fluid leak: This is extremely rare and usually requires treatment.
Note: it is common to have a sensation of air passing through the eyelid after this type of surgery and actually indicates patency of the newly formed bypass.

Lost/dislodged Lester Jones Tube: These tubes can migrate and even fall out and will need to be replaced under endoscopic guidance if have been extruded for more than a day or so.

You will have the eye padded for 24 hours. Minor nose bleeding is common and usually settles spontaneously. Please refrain from hot drinks and nose blowing for 2 weeks to minimise the risk of nose bleeds.

Bruising causing a “black eye” is common. Please use ice packs to the wound 30 minutes 4 times per day for 1 week.

Apply ointment to the wounds and drops to the eye for 2 weeks.

You may have had some tubes inserted at the time of surgery which are easily removed in the clinic at the 3 month mark. If causing irritation can be removed earlier.

Complications can include implant exposure and extrusion which are extremely rare but may require revision or even removal. The socket may need to be expanded to maintain comfortable prosthesis wear, often utilising mucous membrane grafting. Eyelid changes are common after years of prosthesis wear and may require surgical correction in selected circumstances.

Generally patients stay in hospital overnight to manage any nausea or pain. Patients are encouraged to avoid activity in the first few days as there may be minor gaze induced pain. The eye will be padded post operatively. This pad may be taken down after the 4th day and drops started. Drops are continued for at least 4 weeks. At the 6-week mark post op, a prosthesis may be fitted.

We encourage rest for the first 3 days. Minimal analgesia is generally required. Activities can then be resumed as comfort persists. If the eye was a seeing eye, then you must stop driving for 3 months to allow for adaptation of lack of depth perception.