EyeConnect: eyeCONNECTIONS
December 2009

by J. E. "Jay" McDonald 2, Grand.D.

Physicians debate risk

The utilise of makeup is important 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 subsequently surgery is not a small-scale consideration. You may be interested to see how some of your colleagues bargain with this issue and a few other postal service-op restrictions.

Woman applying makeup

Is there any reason to restrict the use of eye makeup following microincisional cataract surgery? What practice the members of this group advise to their patients regarding this? No restrictions? One day? One week?

Jeffrey Horn, M.D.
Nashville

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

Jon-Marc Weston, One thousand.D.
Roseburg, Ore.

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

Michael Kutryb, M.D.
Titusville, Fla.

I place no restrictions any on makeup after the start 24-hour interval, but this raises some other result. Virtually everyone I know places action restrictions on their patients, especially weight lifting. I tell patients they tin do anything they want "short of bungee jumping," but if I size upward the situation, I tell the men who do lifting at work to not lift over 40 pounds for a calendar week. Is it really necessary to restrict activity, fifty-fifty lifting 100 pounds, with microincisional surgery? Or are we simply trying to embrace ourselves with these restrictions?

Mitchell Gossman, 1000.D.
St. Deject, Minn.

Forty pounds for one patient may exist a piece of cake or an impossible dream. I tell patients as long every bit they do non close their mouth and grunt, they may resume activities or weight lifting. They seem to empathize this, and it is the valsalva maneuver with increased IOP that I am concerned about.

J. E. "Jay" McDonald, Thousand.D.
Fayetteville, Ark.

My point is that a properly constructed incision should get stronger with a higher IOP and remain secure (a tautological definition, I understand that). Then after 24-hour interval ane, if the incision looks normal, I see piddling signal in restrictions. I have no uncertainty that patients generate impressive IOPs transiently with bowel movements, sexual practice, middle rubbing, lifting, and and then on. Information technology's a phenomenon that we don't see flat chambers and entrapped IOLs routinely with all the centre rubbing going on. From what I have seen reentering articulate corneal incisions months afterward, there is little healing going on.

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

Mitchell Gossman, M.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 place restrictions on them. I ask them to article of clothing a shield at night for several nights. If they specifically say they elevator heavy weights, such as at the gym, I enquire them to hold off for a week or so. Yet, 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, One thousand.D.

Our patients are instructed to

  • Discontinue eye makeup one week earlier any center surgery.
  • Use Clinique Rinse-Off Eye Makeup Solvent ("the 1 that is a articulate liquid in a blue bottle") to remove it initially.
  • Follow with daily warm compresses and lid 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 individual towelettes.

Years ago, Marguerite McDonald (G.D., Rockville Center, N.Y.) told me that a resident of hers did a project comparing efficacy of various eye makeup removers and that the Clinique product removed heart makeup more completely than competing products or eyelid scrubs with baby 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 within the eye. After surgery, I recommend no middle makeup for two weeks, the same interval as for using topical antibiotic and wearing a shield at bedtime. Any nonsurgical patient in whom we detect corrective debris in the tear film is instructed to be sure that her (it is ordinarily, just not e'er, a female person patient) mascara does not promise to lengthen or thicken lashes, as products that practise so comprise fibers that flake off and autumn into the tear moving picture. Many companies, including Neutrogena and Clinique, offer a "gel mascara." Patients are likewise cautioned not to use cosmetics, particularly eyeliner, across the mucocutaneous junction of the chapeau margin. Nosotros tell them, "Utilise to your skin only, non inside beyond the lashes." Nosotros also recommend that they close 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, Grand.D.
Bala Cynwyd, Pa.

I use atropine at the finish of surgery, and on day v, if the pupil reacts, I add another drop. My only restriction is no reading without readers for 2 weeks. We give them the readers after surgery.

Ray Oyakawa, Chiliad.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

Nigh the author

J.E.

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