17 Oct Your First "Post-Operative" Eye Exam After Retinal Surgery
I routinely examine patients the first day after retinal surgery. It’s the shortest visit you’ll ever have at my office. Surprisingly, there are very, very few things for me to check the first day after surgery.
Whether you have had retinal surgery for removal of an ERM (macular pucker), repair of a macular hole, a vitrectomy for vitreous hemorrhage, floater only vitrectomy (FOV) or retinal detachment surgery; the post-operative exam is brief.
Removal of the Eye Patch
Removing the eye patch can be intimidating. The cotton patch, affixed with paper tape (my favorite due to its’ stickiness), comes off the next morning and stays off. It is usually a bit moist and bloody.
Though a little unsightly, the blood is expected, but insignificant. Also, the eye patch has little therapeutic value.
Especially in cases of a scleral buckle, I like to use a “pressure patch” as it eliminates any lid swelling the next day and facilitates a nice easy exam (sometimes it’s difficult to examine an eye with the lids swollen shut).
Checking the Vision
I expect your vision to be lousy immediately after removing the patch. There are so many reasons why you shouldn’t see, I don’t bother wasting time having you read the eye chart. Simply seeing a strong light is sufficient.
What causes the vision to be so bad?
The cornea is warped from the patch, there might be post-operative bleeding, you might have air or gas in your eye…etc. Therefore, careful measurement is meaningless as it has no bearing on the actual function of your retina (i.e. how well your retina can “read.”)
Checking Your Eye Pressure
This is somewhat important to ensure that the eye is neither too low (not uncommon after 25 gauge sutureless vitrectomy) nor too high (especially with gas injected).
At the end of each operation, I prefer to use stronger dilating drops to keep your eye dilated for a few days following surgery. While it may add to the blurriness after surgery, you will already be dilated for the next morning’s exam…avoiding the need to dilate your eyes again! It may also keep your eye more comfortable for the first few days.
Once the patch is removed, therefore, I can examine your retina immediately, looking for complications of surgery including retinal detachment or infection.
What Does This Mean?
Checking your vision, pressure and looking at your retina is all that I need to examine you after your retinal surgery. Most of the time is spent going over your instructions on how to use your drops and…if needed (it is usually not!), any special head positioning.
Complications immediately following retinal surgery are uncommon, but include; retinal detachment, bleeding, infection and problems with eye pressure. All can be assessed quickly, and comfortably, after your retinal eye surgery!
ElenaPosted at 13:04h, 18 October
You make it sound so easy! 🙂
And I love the teddy bear with the eye patch. 😀
Randall V. Wong, M.D.Posted at 08:10h, 22 October
It really is pretty straightforward. At our office the post-operative exams are indeed the easiest and quickest.
SUSANPosted at 14:55h, 18 October
Hi Doctor Wong,
Your site is so informative, especially for us with retinal problems…Wanted to ask you this question. After 2 operations for both of my eyes for retinal detachment (I’m 43) I had a very big floater in one eye (vitrectomy with s.buckle last Dec.2011) which become smaller in weeks but smaller floaters remained which sometimes glow (glowing circles -especially if there’s light…) Then my other eye (vitrectomy-last 2010) now has a big floater (hollow with black boarder & glows if there’s light and comes and goes? I also have ‘crystal like floaters’ as well and flashes which my doctor said was normal after vitrectomy…
Im so worried…What do these show/mean Doctor? AND BY THE WAY DOCTOR do you accept CIGNA INSURANCE?
Hoping for your reply. Thank you. Susan
Randall V. Wong, M.D.Posted at 08:14h, 22 October
New floaters can be a sign of a new tear. If the floaters have been present since your retinal detachment surgery, than unlikely, but certainly make sure your doctor is aware of them.
Please email Chrissy about the insurance issues. I am pretty certain we participate in some Cigna plans.
In addition, I’ll have her email you?
JulieWPosted at 22:06h, 28 October
I have 2 questions:
1. Is there any correlation between PDR and being anemic?
2. I had a vitrectomy for retinal detachment and ERM (which caused a 2nd area to detach). Initially my vision improved to 20/30 after surgery, a few months later was 20/70, then 20/150 (due to cataract) and was told my best corrected vision would be 20/40. Why can’t glasses correct the vision to 20/20? Thanks
Randall V. Wong, M.D.Posted at 12:30h, 30 October
1. Yes. Anemia can worsen the PDR or make the PDR more difficult to treat. Anemia is a decreased ability to of blood to carry oxygen due to decreased red blood cells. PDR occurs due to loss of normal blood vessels from diabetes, hence, overall reduction of blood to a tissue…resulting in less oxygen.
It’s a double whammy.
2. Glasses can only focus light onto the surface of your retina. If the retina is not healthy, due to ERM, traction, macular edema….you can only see so well.
robin wrexPosted at 21:19h, 09 December
I had Surgery for a retina detachment, cataract and then a pucker within 5 weeks of each other. I am 4 weeks post surgery and have silicone gel in my eye. How long will the gel remain? Also my vision has been slanted since the surgeries and neither the retina nor cataract surgeon knows why. Will it correct itself?
Randall V. Wong, M.D.Posted at 08:31h, 12 December
Dear Robin Wrex,
I usually leave silicone oil in the eye for months. Is this what you mean by silicone gel? Did you have a scleral buckle? Many scleral buckles are made of silicone rubber.
Distortion may be due to the detachment (if the macular were involved) or from the ERM (pucker). Both will take months to resolve…if at all.
Hope this helped.
Alex YPosted at 21:07h, 03 July
Dr. Wong. I have a question regarding the purpose of the dilation drops post op. I’m asking cause I just had a vitrectomy about 8 days ago with no complications to date. The doctor used a similar 25 gauge sutureless vitrectomy to remove floaters in addition to using lasers to seal a small tear in the retina. The next day I was instructed to take three drops; an antibiotic, an antinflammatory and one to keep my eyes dilated. I get the reason for the other two but the dilated one is really bothersome in terms of driving and getting to work. I was wondering, since I won’t be able to see my doctor until next week, would it be ok for me to stop taking the drops? Your answer would be greatly appreciated.
Randall V. Wong, M.D.Posted at 14:48h, 12 July
Can’t speak for or contradict your doctor.
Dilating drops are often used to paralyze the ciliary muscle. While I don’t use them, they are used to prevent pain in cases where there is a lot of inflammation from the surgery itself.