EyeConnect: eyeCONNECTIONS
December 2009

by J. E. "Jay" McDonald II, Yard.D.

Physicians debate run a risk

The employ of makeup is of import to many of our patients. I have noticed it to be one of the first questions many patients ask. Knowing the majority of endophthalmitis cases arise from lid bacteria, makeup usage after surgery is not a small consideration. You may exist interested to meet how some of your colleagues deal with this issue and a few other post-op restrictions.

Woman applying makeup

Is in that location any reason to restrict the employ of center makeup post-obit microincisional cataract surgery? What practise the members of this group suggest to their patients regarding this? No restrictions? 1 day? One week?

Jeffrey Horn, M.D.
Nashville

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

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

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

Michael Kutryb, 1000.D.
Titusville, Fla.

I place no restrictions any on makeup later on the first 24-hour interval, but this raises another issue. Near anybody I know places activity restrictions on their patients, especially weight lifting. I tell patients they tin practice anything they want "short of bungee jumping," but if I size upwardly the situation, I tell the men who do lifting at work to non lift over twoscore pounds for a calendar week. Is it really necessary to restrict activity, even lifting 100 pounds, with microincisional surgery? Or are we just trying to embrace ourselves with these restrictions?

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

Forty pounds for 1 patient may be a slice of block or an impossible dream. I tell patients as long as they do not shut their mouth and grunt, they may resume activities or weight lifting. They seem to understand this, and information technology 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 get stronger with a college IOP and remain secure (a tautological definition, I understand that). So subsequently solar day one, if the incision looks normal, I see little point in restrictions. I have no uncertainty that patients generate impressive IOPs transiently with bowel movements, sexual activity, heart rubbing, lifting, and and so on. It's a miracle that we don't come across apartment chambers and entrapped IOLs routinely with all the center rubbing going on. From what I accept seen reentering clear corneal incisions months later, in that location is trivial healing going on.

Of course, a restriction of no lifting greater than 40 pounds is gratis to the surgeon only might be a hindrance to some patients, and needlessly then.

Mitchell Gossman, Thou.D.

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

Jeffrey Horn, M.D.

Our patients are instructed to

  • Discontinue eye makeup one calendar week before any eye surgery.
  • Employ Clinique Rinse-Off Eye Makeup Solvent ("the ane that is a clear liquid in a bluish bottle") to remove information technology initially.
  • Follow with daily warm compresses and chapeau scrubs till day of surgery, using Ocusoft Plus (Cyancon/Ocusoft, Rosenberg, Texis) or SteriLid (Advanced Vision Research, Woburn, Mass.), preferably the foam rather than the private towelettes.

Years ago, Marguerite McDonald (M.D., Rockville Center, N.Y.) told me that a resident of hers did a projection comparing efficacy of diverse eye makeup removers and that the Clinique product removed middle makeup more completely than competing products or eyelid scrubs with baby shampoo. I commonly signal out to patients who balk at stopping eye makeup that they really exercise not want makeup particles under the LASIK flap or inside the eye. Later on surgery, I recommend no eye makeup for two weeks, the same interval every bit for using topical antibiotic and wearing a shield at bedtime. Any nonsurgical patient in whom we notice cosmetic droppings in the tear film is instructed to exist sure that her (it is commonly, but not ever, a female patient) mascara does not promise to lengthen or thicken lashes, as products that do so comprise fibers that scrap off and fall into the tear moving-picture show. Many companies, including Neutrogena and Clinique, offer a "gel mascara." Patients are also cautioned not to apply cosmetics, especially eyeliner, beyond the mucocutaneous junction of the lid margin. We tell them, "Apply to your skin simply, non inside across the lashes." We also recommend that they close their eyes when applying loose face pulverization. Patients mostly are pleased to have their persistent foreign body awareness cured.

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

I utilize atropine at the end of surgery, and on day five, if the pupil reacts, I add another drop. My only brake is no reading without readers for two weeks. We give them the readers after surgery.

Ray Oyakawa, M.D.
Torrance Calif.

Contact information

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

Well-nigh the author

J.E.

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