EyeConnect: eyeCONNECTIONS
December 2009

by J. East. "Jay" McDonald 2, Yard.D.

Physicians debate risk

The use of makeup is of import to many of our patients. I have noticed information technology to be 1 of the first questions many patients ask. Knowing the majority of endophthalmitis cases arise from lid bacteria, makeup usage later on surgery is non a small consideration. You may be interested to come across how some of your colleagues deal with this issue and a few other post-op restrictions.

Woman applying makeup

Is at that place any reason to restrict the use of eye makeup following microincisional cataract surgery? What do the members of this grouping suggest to their patients regarding this? No restrictions? I day? One week?

Jeffrey Horn, One thousand.D.
Nashville

I don't know of whatever studies to support this, but I have them stop when starting pre-op drops. They can resume usage after i week. Why add together to the bacterial load?

Jon-Marc Weston, M.D.
Roseburg, Ore.

I tell the patients no eye makeup for a week post-op. My goal is to reduce the chances of the patient causing some small irritation or scrape, particularly from mascara or eyeliner, and the resultant worry and telephone call, which takes upward our time at the function. I suppose if the patient was a news anchor or actress, I would bend the rules.

Michael Kutryb, G.D.
Titusville, Fla.

I place no restrictions whatsoever on makeup after the showtime day, merely this raises another issue. Most everyone I know places activity restrictions on their patients, especially weight lifting. I tell patients they tin do anything they want "brusk of bungee jumping," merely if I size upwards the state of affairs, I tell the men who practise lifting at work to not elevator over 40 pounds for a week. Is information technology really necessary to restrict activity, fifty-fifty lifting 100 pounds, with microincisional surgery? Or are nosotros simply trying to embrace ourselves with these restrictions?

Mitchell Gossman, M.D.
St. Cloud, Minn.

Forty pounds for one patient may be a piece of block or an incommunicable dream. I tell patients as long as they practise non close their mouth and grunt, they may resume activities or weight lifting. They seem to sympathise this, and it is the valsalva maneuver with increased IOP that I am concerned about.

J. Eastward. "Jay" McDonald, M.D.
Fayetteville, Ark.

My betoken is that a properly constructed incision should become stronger with a higher IOP and remain secure (a tautological definition, I sympathise that). So after day one, if the incision looks normal, I run into little point in restrictions. I take no doubt that patients generate impressive IOPs transiently with bowel movements, sexual activity, eye rubbing, lifting, then on. It'due south a miracle that we don't meet apartment chambers and entrapped IOLs routinely with all the eye rubbing going on. From what I have seen reentering clear corneal incisions months later, there is petty healing going on.

Of class, a restriction of no lifting greater than 40 pounds is free to the surgeon just might be a hindrance to some patients, and needlessly so.

Mitchell Gossman, Yard.D.

If my patients receive a monofocal or toric IOL or a ReStor (Alcon, Fort Worth, Texas)/Tecnis (Abbott Medical Optics, AMO, Santa Ana, Calif.), etc., I don't place restrictions on them. I ask them to wearable a shield at dark for several nights. If they specifically say they elevator heavy weights, such as at the gym, I ask them to hold off for a week or and then. However, I am much more than cautious with those who receive a Crystalens (Bausch & Lomb, Aliso Viejo, Calif.) for fear the lens may vault and stay vaulted. Are others restricting their Crystalens patients more than than those who receive other IOLs?

Jeffrey Horn, Yard.D.

Our patients are instructed to

  • Discontinue eye makeup one week before any middle surgery.
  • Use Clinique Rinse-Off Eye Makeup Solvent ("the one that is a clear liquid in a blue bottle") to remove it initially.
  • Follow with daily warm compresses and lid scrubs till twenty-four hours of surgery, using Ocusoft Plus (Cyancon/Ocusoft, Rosenberg, Texis) or SteriLid (Advanced Vision Research, Woburn, Mass.), preferably the cream rather than the individual towelettes.

Years agone, Marguerite McDonald (Chiliad.D., Rockville Heart, N.Y.) told me that a resident of hers did a project comparison efficacy of various eye makeup removers and that the Clinique production removed centre makeup more completely than competing products or eyelid scrubs with infant shampoo. I ordinarily point out to patients who balk at stopping middle makeup that they actually do not want makeup particles under the LASIK flap or inside the centre. Later on surgery, I recommend no middle makeup for 2 weeks, the same interval as for using topical antibiotic and wearing a shield at bedtime. Any nonsurgical patient in whom we find cosmetic debris in the tear motion-picture show is instructed to be certain that her (it is usually, but not e'er, a female patient) mascara does not hope to lengthen or thicken lashes, every bit products that do so incorporate fibers that flake off and fall into the tear film. Many companies, including Neutrogena and Clinique, offering a "gel mascara." Patients are besides cautioned not to utilise cosmetics, peculiarly eyeliner, beyond the mucocutaneous junction of the lid margin. Nosotros tell them, "Apply to your skin simply, not inside across the lashes." We also recommend that they shut their optics when applying loose face powder. Patients more often than not are pleased to have their persistent foreign body sensation cured.

Anita Nevyas-Wallace, M.D.
Bala Cynwyd, Pa.

I apply atropine at the stop of surgery, and on twenty-four hour period five, if the pupil reacts, I add another drop. My simply restriction is no reading without readers for two weeks. Nosotros requite them the readers after surgery.

Ray Oyakawa, M.D.
Torrance Calif.

Contact data

Horn: Jeff.Horn@bestvisionforlife.com
Gossman:mgossman@esppa.com
Nevyas-Wallace: anevyaswallace@comcast.net
Oyakawa: RTOyakawa@svcmd.com
Weston: drw@westoneyecenter.com

About the author

J.E.

J.E. "Jay" McDonald Ii, One thousand.D., is the EyeMail editor. He is manager of McDonald Eye Associates, Fayetteville, Ark. Contact him at 479-521-2555 or mcdonaldje@mcdonaldeye.com