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Surgery Information
Scheduling appointments for surgery
Surgery scheduling instructions pertaining to the date, location and time are discussed after your examination by the physician.
Our patient’s needs and family schedules are important to us, and we try our best to accommodate these whenever possible. Our scheduling arrangements for surgery are quite complicated and time consuming; therefore we request your consideration in avoiding rescheduling or canceling your scheduled surgical time at the last moment.
A PREOPERATIVE APPOINTMENT, (at surgeon’s office), usually the day before or day of surgery is required. The patient and parent/guardian need to be present. For adults, you may drive yourself to the preoperative appointment but you may not drive yourself to the surgery.
A POSTOPERATIVE APPOINTMENT (at surgeon’s office) is usually required within a day or two after surgery. For children and adults having eye muscle surgery the appointment is often two to three days following surgery. For children having cataract surgery, the postoperative appointment is typically the day after surgery. Your doctor will advise you about the exact timing of the postoperative appointment(s).
Preparing your child for surgery
Children will not require blood work or any shots prior to surgery unless the child has a specific medical condition which would require blood work. No aspirin or aspirin derivatives may be taken for two weeks prior to surgery. Have the child wear comfortable clothing, like PJ’s. You may want to bring a favorite toy or stuffed animal for comfort.
A short stay in the hospital can be stressful for children. It may consist of unfamiliar routines, people, and machines. Sometimes it may seem less stressful not to tell your child about having surgery, a test, or even going to the hospital. However, research and experience tell us that children benefit most from honesty and simple explanations. They will develop trust, understanding, and confidence through these explanations.
Infants to Three years: a simple mention of the upcoming event one to two days prior to surgery. Reassure your child that you will be going with them to the hospital and returning home with them. It is important for you to be there for your child. The more calm and relaxed you are the more relaxed and calm your child will be as well.
Preschoolers: One to two days in advance is sufficient time to provide explanations to the preschooler about the hospital. They tend to understand simple descriptions about surgery and procedures. Parents can reassure and support their children even before the hospital experience has begun.
School-Aged Child: School aged children unlike toddlers and preschoolers are more able to understand surgery. They can think and reason logically and tend to have a better understanding of the concept. It is important to let your child know the feelings that they are experiencing (being scared) is okay and that you are there if they want to discuss their feelings.
Adolescents: Hospitalizations affects teenagers just as it does young children. However, there are different needs involved. During adolescence there is an increased need for independence and hospitalization my cause a loss of independence. Teenagers are private and sometimes would rather discuss their feelings with a friend instead of a parent. It is important to respect their privacy. Encourage your teenager to make a list of questions for the medical staff and bring them to the hospital. It will give them a sense of control.
Preparation for the Adult Patient
Depending on age and medical history a physical may be required. Adults will be asked to have blood work drawn, and possibly an EKG and/or chest X-ray performed. This needs to be done within two weeks prior to surgery. Physician orders will be given to you when you schedule the surgery. The office needs the results by the date of the preoperative appointment to review for anesthesia purposes.
NO ASPIRIN OR ASPIRIN DERIVATIVES MAY BE TAKEN FOR TWO WEEKS PRIOR TO SURGERY. Do not bring any valuables with you to the hospital. Wear comfortable clothing. You may want to bring slippers and a robe.
Fasting prior to surgery
Fasting will be required. For adults, the requirement is typically no food or drink after midnight the day before surgery. The anesthesiologist contacts you 1-2 days prior to surgery. If you have to take a medication the day of surgery, check with your anesthesiologist or surgeon. For children, the hospital nurse will be calling to advise you of fasting instructions.
Postoperative expectations for strabismus surgery
Nausea: Quite common after eye muscle surgery. May last 24-48 hours.
Diet restrictions: Go easy on food the day of surgery. Start with sips of clear liquids, carbonated beverages, Popsicles, or ice chips. Later in the evening you may have soft foods such as ice cream, pudding, Jell-O, soup if tolerated. Appetite usually back to normal by the second day and you may resume your regular diet.
Pain/discomfort Light sensitive for 1-2 days post-op. Eyes will feel scratchy for 1-2 days post-op. May have pain on rotating the eyes for approximately one week. Most stitches are buried and will dissolve on their own. Swelling next to conjunctiva and dry spots on the cornea may occasionally cause a scratchy sensation 3-5 days following surgery. Some may need Tylenol or Motrin for pain: occasionally something stronger but only in particular cases. If the eyes feel dry or scratchy it’s okay to use over the counter drops to lubricate the eyes, such as artificial tears.
Appearance of the eyes Red eyes for 10 days to two weeks. 90% of redness clears within two weeks. Some pinkness remains and gradually fades over several months. Children heal faster than adults. May have bloody discharge/matting of lashes, lasting approximately two days after surgery: the eyes may stick together in the morning: wipe eyes with a damp cloth.
Activities: You’ll be tired the day of surgery and will probably want to sleep the rest of the day. You’ll feel much better the second day after surgery. You/your child may resume normal activity if desired, usually after the second day, okay to return to school/work 1-2 days after surgery. Normal activity will not damage the eyes. Each person is different regarding recovery time. Some may want to take 1-2 weeks off following the surgery while others are ready to return to their regular schedule a few days after surgery. Driving is okay when you feel that it is safe to do so. It’s okay to fly anytime after surgery. Contact sports, swimming in a pool, eye make up, playing outside or in a sandbox are allowed 2-7 days after surgery. No swimming in a lake for 1 week.
Post operative medications/treatment: Continue with all medications the day after surgery. Oral antibiotics are given to both adults and children for the first 5 days following surgery. Start the day after surgery. TobraDex drops are sometimes given to adults four times a day for about 10 days after surgery. Ice or cold packs to the eyes the first few days post-op will often reduce any swelling that may be present. There will be no patches or bandages after surgery.
Postoperative strabismus/diplopia: It takes approximately 6 weeks for the eyes to heal and gain their full function; therefore a lot of eye alignment changes take place during this time. Must allow a full 6 weeks before the outcome of the surgery can be accurately assessed. Adult double vision usually fades during the first 6 weeks post-op. Adults may patch one eye if too uncomfortable from the double vision, but we recommend that they try to tolerate it so that the brain may try to get used to the two eyes working together. Children may experience double vision if eyes cross inward after surgery; this usually clears in three weeks as the crossing goes away. Usually wait two weeks after surgery before resuming patching or Atropine for amblyopia.
Danger signs: Increased swelling/pain of the conjunctiva and eyelids after the first 24-48 hours following the surgery may be serious and should be discussed with the doctor or nurse. Conjunctival swelling and a yellowish discoloration of the white part of the eye without pain may be just a reaction to blood absorbing. Adults with increased complaints of generalized pain (not just from looking in a particular direction) 2-3 days post op could be suffering from anterior segment ischemia (lack of blood to anterior segment). This is rare and should be seen by the doctor. SUDDEN changes in the eye alignment (overnight) may indicate a slipped muscle. This is also rare and should be seen by the doctor. The most critical time for infections and problems to occur is during the first week following the surgery.
Cataract surgery expectations
Cataract surgery takes about 45 minutes and is performed under general anesthesia. The white part of the eye will be very red with a watery discharge. For one day, a bandage is used and then a shield is used to protect the eye for several days. An antibiotic is given to prevent infection. A steroid treats inflammation and a dilating drop to dilate the pupil.
We may measure the curvature of the cornea for fitting contact lenses. If required, at the time of the surgery on the second eye, the first eye operated on may be examined to measure for the strength of a lens or to check the retina. The intraocular pressure may be measured. After surgery your child will be able to see shapes, such as a person, but no detail such as facial details.
There is usually internal irritation or inflammation after surgery. This can be associated with light sensitivity. ANY PAIN, SWELLING OF THE EYELIDS, A CLOUDY CORNEA OR FEVER SHOULD BE REPORTED TO YOUR DOCTOR. The eye bleeds very little. Sometimes there are a few drops of blood from the small vessels on the surface of the eye. Mild pain is present and can usually be managed with Tylenol.
Nasolacrimal duct probe and irrigation and stent placement
These procedures, when done under general anesthesia, follow the same guidelines for preparing your child for surgery and fasting (see above).
After surgery, tearing with discharge or bloody tears is common and usually resolves after a day or so. Tylenol may be given for pain. No bandages are required. You may be asked to instill eye drops following surgery. Oral antibiotics are typically not required.
Insurance
Our office will contact your insurance carrier and execute the necessary pre-certification or notification regarding your surgery. You will receive a letter or telephone call advising of the payment obligations.
HMO, EPO, POS and all managed care insurance plans require an up to date referral. Please double check that a referral is in place prior to surgery. If it is not, it may delay your/your child’s surgery.
The surgical facility and anesthesiologist will bill separately for their services. |
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