Ost Operative Care: General Instructions For Post Operative Patients After Eye Surgery
Ost Operative Care: General Instructions For Post Operative Patients After Eye Surgery
Ost Operative Care: General Instructions For Post Operative Patients After Eye Surgery
01. Eye shield: Please use eye shield for protection when you sleep. You may use dark glasses during daytime. Please wash
the eye shield and glasses with soap and water each day and dry the same before use.
02. Washing the face: Cleaning of the operated eye will be as per the instructions given by the doctor/ nurse. The rest of the
face can be mopped with a clean and wet cloth. Avoid splashing water into the operated eye.
03. Shaving: Shaving is permitted. But avoid splashing water after shaving. Instead, clean with a wet cloth.
04. Bathing: You can bathe below neck from the first postoperative day itself. But avoid head bath for a period of 3-4 weeks.
05. Use of facial cosmetics: Avoid cosmetics to the eye such as mascara, eye liners etc for at least 4 weeks.
06. Physical activity: Activities such as walking, talking, TV viewing can be resumed immediately after surgery. However,
Jogging, swimming, gardening, contact sports, etc may have to be avoided until 4-6 weeks after surgery.
07. Driving: Avoid driving till your surgeon gives you permission.
08. Joining back duties: Usually you will be allowed to join your duties by 4-6 weeks after surgery depending upon the
surgery. You may have to check with your doctor regards to the exact date of joining duty.
09. You may resume your sexual life a week or two after the surgery.
10. The following symptoms may be expected after most surgeries: Some amount of redness, watering, foreign body
sensation, and glare are common. The severity varies with the type of surgery. These symptoms will reduce with time and
usually disappear by 4-6 weeks.
11. If you have any worsening of the symptoms and specifically if there is increasing redness, pain or decreased vision please
report as emergency to the Sankara Nethralaya premises at 18, college Road, Nungambakkam.
B. The attendant performing this task should wash the hands with soap and water and dry them with a clean towel.
C. You may use the disposable tissue supplied at the hospital for this purpose.
D. Cleaning the lower lid is done by asking the patient to look up and wiping all the secretions sticking to the lower lid
margin.
E. Cleaning the upper lid is done by asking the patient to look down and doing similar procedure.
F. Similarly the outer and inner corners of the eye are cleaned.
G. Once the margins and corners are cleaned, the eye drops can be instilled and then the surrounding areas can also
be cleaned.
A. The attendant should wash his/ her hands with soap and water.
B. The cap of the eyedropper bottle is opened carefully without contaminating the tip of the nozzle.
C. Pull the lower lid and place the drop between the eyeball and the lid by squeezing the bottle or cap as the case may
be.
E. The eyes should be kept closed for a period of 5 minutes after the drop is instilled.
14. Procedure for instilling eye ointment:
C. The tube containing the ointment is squeezed gently so that a small thread of the ointment falls in the space between
the eyeball and the lid. This should be not more than half a centimeter.
C. Keep the eye closed for 5 minutes after applying the medication.
F. Make sure that the right drops are being used for the right number of times.
G. If similar medication is advised for both eyes, it is advisable to have separate bottles for the two eyes.
H. Unused eye medication, once opened is discarded and never used for other persons.
16. General instructions:
C. Do not allow the eye to get injured- the eye shield is meant to protect the eye from physical hurt.
D. Avoid too many visitors for fear of contacting infection- especially avoids visitors with conjunctivitis, cold etc.
E. Do not play with children since there is possibility of getting hurt in the eye.
J. Avoid using handkerchief to mop the eye. Use sterile tissue only.
M. If gas has been injected into your eyes as part of the treatment process, you should avoid air travel for minimum of
2 months or as instructed by your surgeon.
N. You should maintain head down/prone position after retinal detachment surgery, if silicon oil or gas bubble has been
placed inside the operated eye.
Nuclear: Nuclear cataracts are the most common type in the aging lens
and involve the central part of the lens.
Cortical: Cortical cataracts involve the outer layer of the lens and are
often associated with childhood cataracts.
Level of maturity/progression
Phacoemulsification surgery is now the standard method. This involves a small cut made in the front
part of the eye. Through this hole a fine instrument is used to dissolve the hard lens and the dissolved
lens is suctioned out. This whole process is called phacoemulsfication. A folded, artificial lens implant
is then placed within the empty lens bag and allowed to unfold. Careful washing of the lens is
undertaken in order to remove any left over lens matter. Often stitches are not required as the cut is
so small and is therefore self-healing.
Extracapsular surgery used to be the most widely practiced method of surgery, prior to the
phacoemulsification technique. It involves a larger cut and the entire cloudy lens is removed from the
eye. A non-folding artificial lens is inserted and the cut is closed with stitches. This procedure is
sometimes associated with problems in the wound closure.
Intracapsular surgery is now only used in special situations. It involves removal of the entire lens as
well as the surrounding lens capsule.
Complications of surgery
CataractsAlthough modern techniques make cataract surgery very safe, complications can still occur.
While not common, there are certain risks including:
Infection
Bleeding
Eye perforation
Retinal detachment
Glaucoma
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1. Apply the eye drops as per the schedule provided by the ophthalmologist. In any case, you
have to strictly adhere to the routine provided by the doctor. Eye drop needs to be applied daily for a
few weeks after the surgery.
2. You may resume light day-to-day activities such as watching TV, reading, writing and
walking. Always keep your physical activities light.
3. Wear your protective eye cover always, even when you are sleeping. And always sleep on
the side that hasn’t been operated on.
4. When taking a shower, keep your eyes closed. Make sure that water or soap doesn’t enter
your eyes.
5. On the day of surgery, as well as the next day after the surgery, it is important that you rest
and relax properly. This promotes healing.
6. After the surgery, the doctor will provide you with a protective shield, and you have to wear
it on your operated eye until the doctor says that your eyes are fit enough to go without the shield.
The doctor will also give you special eye shades in case you have to go out.
Don’ts
1. Never rub your eye or apply anything to your eyes, even water. This will increase the
chance of infection.
2. Immediately after the surgery, avoid bending. This prevents putting extra pressure on your
eye.
3. Never swim or use a hot tub, at least for two weeks after the surgery. Even a small drop of
water makes your eyes vulnerable to infection.
4. Do not drive for 24 hours after cataract surgery.
5. Do not indulge in any strenuous activity, such as strenuous exercise, lifting weights etc. This
should be followed for at least the first week following the surgery. Your eyes need about a month to
fully recover. So it’s safe to avoid strenuous activity during this time.
6. Do not wear any eye makeup until your ophthalmologist allows.
7. Avoid any activity that exposes your eyes to dirt or dust. Patients who stay in dry and dusty
environment should avoid going outdoors. When going out, you must wear a special protective
eyewear provided by the doctor. Dust and sand particles may scratch your eye surface making the
eye prone to infection.
8. Be careful when walking around after surgery. Try not to bump into doors or any other
objects.
Usually, after a cataract surgery, you should be able to perform these activities within a few hours:
Working on a computer
Watching TV (not for long hours)
Showering
Iridectomy
move slowly, keep his head raised, and sleep with two
pillows under his head.
Laser surgery
Scleral buckling
-Visual aids
-Changing eyewear prescription
-Reading glasses
-Magnifiers
-Increased lighting
-No driving at night
-Psychosocial help
-Occupational and lifestyle adjustments
-H and P
-Eye drops (NSAIDS, dilating)
-Antianxiety meds
-Local anesthesia
Cortical cataracts: These form around the edges of the nucleus (lens),
creating a wedge shape or the development of streaks along the outer lens
cortex. The cataract begins as a whitish tint and slowly progresses with
streaks edging closer to the centre of the nucleus. This then progressively
interferes with the ability of light to pass through the lens centre.
Congenital cataracts: A baby is born with cataracts (in one or both eyes)
due to infectious causes, injury or impaired development in the uterus
during pregnancy (intrauterine infection or trauma). A baby may also be
born with a susceptibility for developing cataracts within his or her first
year of life.
Incision
Capsulorhexis
Hydrodissection
Phacoemulsification
Irrigation –aspiration
IOL Implantation,
MAJOR- EARLY
Endophthalmitis!!
Photophobia
Periorbital edema
Ciliary injection
Corneal edema
Hypopyon - Collected white material in the anterior chamber
Treatment: URGENT!!
Vitreous tap-biopsy
Systemic antibiotics
Topical antibiotics-fortified
Intravitreal antibiotics
MAJOR-LATE
Bullous Keratopathy
IOL Malposition
Retinal Detachment
OTHER - EARLY
OTHER- LATE
Wound gape
İris Trauma
Zonular Rupture
Posterior Capsular Rupture
Vitreous Loss
Vitreous Hemorrhage
Choroidal Hemorrhage!!
Uveitis
IOL Dislocation
ANATOMY OF THE LENS A biconvex structure attached to the
ciliary process by the zonular fibre, between iris & vitreous humour
Non-vascular, colourless and transparent Index of refraction 1.336
Consists of stiff elongated, prismatic cells known as lens fibre, very
tightly packed together Divided into nucleus, cortex and capsule The
whole lens enclosed within an elastic capsule Helps to refract incoming
light and focus it onto the retina
16. CLASSIFICATION
34. DIABETES & CATARACT Cells use glucose for energy. This
normally occurs by phosphorylation via the enzyme hexokinase.
However, if large amounts of glucose are present (as in diabetes mellitus),
hexokinase becomes saturated and the excess glucose enters the polyol
pathway when aldose reductase reduces it to sorbitol.
36. POLYOL PATHWAY The retina cells use glucose for energy as
normal, and any glucose not used for energy will enter the polyol
pathway. When blood glucose is normal, this interchange causes no
problems, as aldose reductase has a low affinity for glucose at normal
concentrations. In a hyperglycemic state, the affinity of aldose
reductase for glucose rises, causing much sorbitol to accumulate. This
change of affinity is what is meant by activation of the polyol pathway.
40. PE FINDINGS Visual acuity is impaired for both distance and near
and patient may even be blind. Opacity in the lens Ocular adnexia
and intraocular structures when examined may reveal lesions that may
point at - The cause, type and eventual visual prognosis If RAPD
positive, this indicates an optic nerve disease or extensive macular lesions
- Visual prognosis guarded in such cases
44. LENS OPACITY Normal eye – Good red reflex Cataractous eye –
Poor red reflex
45. MANAGEMENT
53. ICCE VS ECCE ECCE ICCE Small incision 5-6mm Large incision
10-12mm Posterior lens conserved Removal entire lens No stiches
required, self healing Required stiches, long rehabilitation time IOL
implant Aphakic eye Post operative complication minimal Added risk for
retinal detachment, corneal edema and vitreous loss
Following factors are generally involved in the development of the congenital cataracts.