Eyelid reconstruction is required usually after a skin lesion has been removed from the eyelid or face. In some cases the lesion may need to be removed because it is cancerous or malignant (such as a basal cell carcinoma) although we do remove benign lesion also that may require reconstruction. Patients who undergo Mohs surgery will usually need some form of reconstruction afterwards as a second stage.
The other reason for performing eyelid reconstruction is after an injury to the eyelid. The reconstruction may be performed immediately after an injury such as a laceration or in some cases as a second procedure to correct a malposition of the eyelid.
The eyelid is reconstructed using a variety of techniques. The aim of the surgery is to return the eyelid to its natural position and to cosmetically match it to the other side.
In many cases we can simply close the defect directly but sometimes we may need to use tissue from elsewhere. This can include flaps of skin from nearby the wound, skin grafts and in some cases tissue from inside your mouth. These options would be discussed with you prior to the surgery so that you know what to expect.
The risks of surgery include postoperative bleeding, scarring to the eyelids, dry eye and infection. If the tear duct is involved in the surgery you may well have a watery eye postoperatively.
Occasionally we may under or over correct the position of the eyelid. Most of these complications can be corrected if required with a second operation. In cases of adult surgery this correction can be performed in the minor operation room.
The most serious risk of any eyelid surgery performed is damage to your eyesight. Fortunately this risk is extremely rare.
On the day of surgery you will be told a time and place to come in to the hospital. You will be met by the nursing team and one of the surgical team will also see you.
If you are for day case surgery you will need to make sure that someone can be with you on the evening of surgery. If you are coming to stay the night you will need to bring some overnight clothes and toiletries for the duration of you stay. We advise that you also bring in your medications with you when you come into hospital.
This type of surgery is usually performed as a day case operation and we normally allow you to go home about 60 minutes after you surgery is finished.
The eyelids will be bruised after surgery and you may have some blood stained tears which is quite normal initially.
Following the surgery we may close the eyes with some stitches and you may be padded for 3-4 days.
We usually see you 1-2 weeks after surgery to remove any sutures. In cases where we have used flaps we may need to divide the flap at about 2 weeks after the surgery.
Normally we ask that you keep the wounds around your eye clean after surgery. You can clean the wound by allowing boiled water to cool and then gently dabbing the wounds with a cotton bud.
We will give you some antibiotic ointment (usually Chloramphenicol) to apply to the wounds and to the eyes after the surgery to help protect against infection. In addition you will be given a lubricant ointment to further protect the eye.
We normally advise that you apply ice compresses to the eyelids after surgery for three times a day for 5 minutes each time. This is to help reduce the bruising.
We will see you 1-2 weeks after surgery to remove any sutures.
You should avoid any strenuous activity including lifting heavy objects for at least two weeks and avoid swimming for three weeks after surgery.
Usually patients are quite anxious after having surgery near their eyes and most problems do settle with time. Problems that require immediate attention are the onset of new double vision, loss of vision and pain that cannot be controlled with regular painkillers.
Please refer to the emergency contact page (in contacts) if you need advice.
Author: Mr Jonathan Norris FRCOphth