Austin McCormick

                                                  Consultant Ophthalmic and Oculoplastic Surgeon MBChB, FRCOphth

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Tel: 01517098442                             Fax: 01517097509                                Email:                               Address:  86 Rodney Street  L1 9AR UK

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Eyelid and Tear Duct Trauma

Click here to see before and after photographs                                                                 Eyelid-and-tear-duct-trauma-photographs.html

What is eyelid and tear duct trauma?

  1. The eyelid, when injured, may lacerate or tear.

  2. The beginning of the tear duct called the canaliculus is in the eyelid, therefore if the eyelid is torn it may also tear the duct.

What are the benefits of surgery?

  1. Surgery is carried out to suture the eyelid back together. This ensures that a notch or defect does not form in the eyelid.

  2. It also makes sure that the eyelashes remain in a line.

  3. If the laceration involves the canaliculus (tear duct) this can be repaired.

What is eyelid and tear duct trauma surgery?

  1. The two cut ends of the eyelid are stitched back together.

  2. The deep sutures used are dissolvable. The skin sutures have to be removed a week later.

  3. To repair the tear duct a stent is placed inside it, running from the eyelid through the canaliculus, down the tear duct and into the nose (see diagram above). The stent is only 1 millimeter thick and made of very fine rubber.

  4. The only part of the stent that you will be able to see is a few millimeters of it running from the upper lid canaliculus down into the lower lid canaliculus.

  5. The stent may be left in for up to 6 months and is removed simply in clinic.

  6. The operation should take approximately 45 minutes to complete and is usually carried out as a day case.

  7. The operation may be carried out under local anaesthetic without sedation. After anaesthetic drops have been put in both eyes, an injection of local anaesthetic is given just beneath the skin of the upper eyelid. This is similar to dental anaesthesia and usually takes less than 30 seconds to give.

  8. Local anaesthetic with sedation involves an anaesthetist administering intravenous sedation via a drip so that you are very relaxed and may not remember having the operation.

  9. General anaesthetic means that you are completely asleep.

Are there alternatives to surgery?

  1. It is not possible to correct the problem without surgery.

  2. Without surgery the eyelid may not align properly leaving the eyelashes out of line or rubbing on the eye.

  3. A notch may form in the eyelid.

  4. If the tear duct is not repaired you may develop a watery eye.

What will happen before surgery?

  1. Before the operation you will be seen in the clinic by Mr. McCormick.

  2. He will ask you about the eyelid problem. He will also ask about other medical problems you have, medications you take and any allergies (bring a list or the tablets themselves with you).

  3. He will examine your eyes.

  4. If you are to proceed with surgery the operation will be discussed in detail. This will include any risks or possible complications of the operation and the method of anaesthesia.

  5. You will be asked to read and sign a consent form after having the opportunity to ask any questions.

  6. If you are to have a general anaesthetic or local anaesthetic with sedation you will also see a preoperative assessment nurse. She/He will carry out blood tests and an ECG (heart tracing) if required. She/He will also advise you if you need to starve before the operation.

  7. If simple local anaesthesia is used you will not need any of these investigations and you will not need to starve prior to surgery.

What should I do about my medication?

  1. Mr. McCormick will want to know all the medication that you take and about any allergies you have.

  2. In some cases you may be asked to stop or reduce the dose of blood thinning tablets like: warfarin, aspirin, clopidogrel (plavix), dipyridamole (persantin). This decision is made on an individual basis and you should only do so if it is safe and you have been instructed by your GP, surgeon or anaesthetist. This will be discussed with you before surgery.

  3. You should avoid non steroidal anti inflammatory medications for 2 weeks prior to surgery. Other medication should be taken as usual.

  4. You should avoid herbal remedies for 2 weeks prior to surgery as some of these may cause increased bleeding at the time of surgery.

  1. What are the risks and possible complications of surgery?

  2. All surgery caries a risk of bleeding and infection, both are fortunately uncommon in these operations.

  3. Infection might present as increased swelling and redness of the skin. There might also be yellow discharge from the wound. It is treated with antibiotics.

  4. Bleeding may present as fresh blood oozing from the site of surgery or a lump appearing near the wound after the operation. Simple pressure on the area is usually enough to control minor bleeding.

  5. A collection of blood (haematoma) may be massaged and will usually settle without further surgery.

  6. Whenever the skin is incised a scar may form. Every attempt is made by the surgeon to minimise and hide scars but sometimes they can be visible. 

  7. The eyelid is in close proximity to the eyeball. Although extremely unlikely, whenever surgery is carried out close to the eye there is a potential risk of damage to the eye and therefore to eyesight.

  8. You will have the opportunity to discuss the risks and benefits of surgery and anaesthesia with Mr McCormick and the anaesthetist prior to surgery.

What should I expect after surgery?

  1. Usually a pad will be placed on the eye, which will remain until the following day when you can remove it. For 10 days the wound should be cleaned using boiled water that has cooled down and sterile cotton wool balls.

  2. After the pad is removed, antibiotic ointment should be applied to the skin wound and the eye three times a day for 2 weeks.

  3. It is normal for there to be swelling of the eyelid following surgery. This gets worse over the first 48 hours then starts to improve. It may take up to 6 weeks to resolve.

  4. The skin sutures used will be removed at 7-10 days in clinic.

  5. The time when you can return to normal activities varies from person to person. Many are happy to do so after 2 – 3 days and the vast majority after a week.

Postoperative Instructions

  1. If an eye pad is placed it should remain until the next morning when you may remove it.

  2. For the first 10 days clean the wound using either sterile water sachets or boiled water that has cooled down and sterile cotton wool balls.

  3. Chloramphenicol ointment to the eye and wound, three times a day for 2 weeks

  4. Follow up appointment 1 week later.