Eyelid Surgery – Possible Complications

Tristan McMullen is a specialist eye surgeon at Aurora Clinics in Northamptonshire. In this video he explains the possible complications you could encounter following eyelid surgery and how to avoid them. For more information please visit the Eyelid Surgery information page, or ring us on 01844 214362.

Eyelid Surgery – Possible Complications

My name’s Tristan McMullan. I’m an eyelid surgeon. I’m an ophthalmologist who specialises in surgery around the eyes. I’ve been asked to talk today about some of the complications that can arise from having surgery to your eyelids. I think it’s important that patients do realise that there are potentially serious problems that can relate to eyelid surgery. Fortunately, these are very rare and with the right kind of preparation one seeks to minimise these risks altogether.

I tell patients that one of the complications they’re going to get is bruising, and I tell them this is almost guaranteed. To a certain extent, they can moderate the amount of bruising they get by their post-operative care. That’s the subject of another video. Bruising is a given.

Infection is very, very unlikely in surgery around the eyelid but is always possible. We seek to minimise this by proper surgical technique. I don’t, personally, give oral antibiotics after surgery, but I do ask patients to apply antibiotic cream.

The incision site does take a while to heal and sutures, stitches are normally removed at about five to ten days. The incision goes through a process of healing and can look a little bit red for a while but then goes white and then eventually fades away. A scar, which is a word we try not to use, is visible for a while, but usually that heals up with no visible trace.

The most dreaded complication from eyelid surgery is loss of vision. That would be caused by a haemorrhage behind the eye, a so-called retrobulbar haemorrhage. Fortunately these are exceedingly rare, but they have been described. Part of my post-operative regime involves having patients avoid heavy lifting or bending so that they keep their head above their heart. I perhaps overplay this a bit, but I’m absolutely determined that I should never encounter this. These are some of the things that can be done to avoid it. That is a devastating complication which can result in either partial or total loss of vision in the eye that’s operated on. It’s of the order of about 1 in 10,000. It is rare but it does exist.

The most easily avoided complication that, unfortunately, is sometimes encountered is when patients have too much eyelid skin removed. Patients often come in seeking the removal of excess eyelid skin. If you take too much skin from the upper eyelid, then patients find that they can’t close their eyes which give them chronically uncomfortable eyes. This is something that needs to be discussed very carefully with patients, particularly in the cosmetic setting where they’re paying money for effectively skin removal. To some extent, there’s an expectation that the more skin you remove the more value you’re getting for your money. You can take this to a certain point, and once you push it further than that, you get the law of diminishing returns and unhappy patients.

Similarly in the lower lid, if you end up taking too much skin you get lower lid retraction. You start to see the white of the eye below the coloured part of the eye. That’s an abnormal appearance and one should seek to avoid.

Those are two things that obviously relate to surgical technique but would come down to complications if they were to happen. I always advise patients that they will get a dry eye after surgery, particularly surgery to the upper lid. This lasts about six to eight weeks, and I have them use eye drops to alleviate this. It’s usually a temporary phenomenon.

I tend to be cautious with patients who have had laser eye surgery, either LASIK or LASEK, because this often gives them pre-existing dry eye which can then be worsened. I would be very cautious in my skin removal in these patients. I would counsel them accordingly.

Other than that, I mean anything can happen in surgery, but those are the sort of common things that I like to run over with patients before surgery and make sure that they fully understand that they are embarking on a procedure that unfortunately does, ultimately, in the worse case scenario have a very, very serious consequence, i.e. loss of vision. Fortunately, we know what we’re doing and these complications are rare, but it would be a fallacy to pretend that they don’t exist. Thank you.