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PRE-OPERATIVE EVALUATION
You
will need a note from your/your child’s medical doctor before
admission to the hospital. Please bring this with you.
Laboratory work may or may not be needed. This will be done if
necessary the day before or the morning of surgery.
Sometime in the afternoon on the day prior to surgery you will be
contacted by the hospital. The time of the last feeding prior to
surgery will be reviewed. This will depend on the age of the patient
and the time of the surgery. The importance of an empty stomach prior
to anesthesia will be emphasized. All food and fluid will need to be
held after a certain hour.
PURPOSE OF THE SURGERY
This
information is given to you so you can make an informed consent
decision about proceeding with ptosis surgery on you/your child. You
have the right to ask questions about any procedure before agreeing to
have the operation.
Ptosis surgery is undertaken to correct the height of the lid in one
or both eyes. This surgery can improve the field of vision; help
correct significant compensatory head position and can decrease the
risks of amblyopia (lazy eye) or improve its management. The age of
the patient and the severity of ptosis as well as the overall function
will determine the relative urgency for the timing of surgery.
Your child does not have to undergo ptosis surgery but the reason this
has been recommended is because we have reached maximum results with
alternative treatment. The lid position will improve significantly but
with this type of surgery there is a probability of under or over
corrections, some of which may require further surgery. In general,
the reoperation rate short-term is less than 10%. In long-term, that
is, several years in the future, reoperation rate varies between 20
and 30%. In order to improve the lid position in primary position
straight ahead, we will have a lag of the lid in down-gaze, exposing
the superior sclera (white part) of the eye. The eye may not close
completely while asleep. Usually artificial ointment is necessary for
the first couple of weeks after surgery but occasionally it needs to
be continued at bedtime and/or with associated artificial tear drops
during the day.
RISKS
Complications of surgery are unlikely but they may include hemorrhage
(bleeding), infection, irregularities of the lid contour, extrusion of
suture material and even effects on the vision including total loss of
vision. Problems of bleeding, infection, glaucoma (high pressure
inside the eye), retinal detachment, or reaction of the tissue in the
eye (inflammation) could even lead to complete loss of the eye. These
are recognized risks that can occur after ptosis surgery.
As with any surgery, there is a possibility of other complications due
to anesthesia or drug reaction. It is impossible to state every
complication that may occur as a result of surgery. Therefore, this
list is incomplete.
RECOVERY ROOM
Following surgery the patient is taken to the recovery room where
special nurses and equipment are available. Here the recovery from
anesthesia is supervised. When a satisfactory state of consciousness
returns, the patient is sent to a separate room. The family can rejoin
the patient at this time.
POST-OPERATIVE COURSE
Eating: Until the patient is well awake nothing by mouth should be
encouraged. Once awake, the patient may have ice chips or small sips
of a beverage. Nausea may occur after the administration of
anesthesia. Large quantities of food should be avoided in the
immediate post-operative period as they can irritate the stomach.
Usually the patient is able to resume a regular diet the day following
surgery.
Bandages: The incisions in the operated eye(s) will be covered a
greasy ointment and possibly a soft dressing. It is important to try
to prevent rubbing. Rubbing can cause the stitches to open. In
addition to structural damage this can cause infection.
Tearing: Tearing may occur the first few days after surgery. If it is
bothersome, they can be gently wiped away with a tissue or other soft
material like a towel.
Pain:
Generally there is little or no pain. The eyes may be sensitive to the
light due to inflammation. Over the counter medications such as
Tylenol or Advil are usually sufficient. Only very rarely are
prescription pain killers needed. If severe pain associated with
tearing is present, you should contact the surgeon immediately.
Activity: All patients are allowed up with supervision the same day.
Infants and small children may be held in the parents’ arms. Swimming
and contact sports are not permitted for four weeks. Keep soap and
water out of eyes while bathing.
Glasses: The eyes may be light sensitive following surgery. In this
case, older patients will appreciate sunglasses or wide-brimmed hats.
Younger patients may choose to close their eyes to avoid the light. If
glasses are worn before surgery, they will probably be continued
immediately after surgery. They may be modified at some time during
the post-operative period.
Medications: After ptosis surgery antibiotic eye ointments are
required. Antibiotic ointments are used to prevent infection.
Additional medications such as eye lubricants may be added to the
regimen.
Office visits: Generally the first checkup is on the next day
following surgery. The dressing is removed. Regular visits will then
be scheduled at regular and frequent intervals. If there is any
problem between scheduled visits, it should be reported and additional
visits can be arranged.
LONG-TERM COURSE
Treating the child after the surgery is of the utmost importance in
the final visual outcome. This treatment will continue until the
visual system is mature, sometime BETWEEN FIVE AND TEN YEARS OF AGE.
The expected treatment may include contact lenses and/or special
glasses, use of a patch over one eye, and close medical supervision.
More surgery may well be needed. All this treatment is in addition to
the present ptosis surgery. General medical problems may well require
additional care from other medical specialists.
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