Physicians debate risk
The use 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 after surgery is not a small consideration. You may be interested to see how some of your colleagues deal with this issue and a few other post-op restrictions.
Is there any reason to restrict the use of eye makeup following microincisional cataract surgery? What do the members of this group suggest to their patients regarding this? No restrictions? One day? One week?
Jeffrey Horn, M.D.
I don’t know of any studies to support this, but I have them stop when starting pre-op drops. They can resume usage after one week. Why add 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 minor irritation or scrape, particularly from mascara or eyeliner, and the resultant worry and 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.
I place no restrictions whatsoever on makeup after the first day, but this raises another issue. Virtually everyone I know places activity restrictions on their patients, especially weight lifting. I tell patients they can do anything they want “short of bungee jumping,“ but if I size up the situation, I tell the men who do lifting at work to not lift over 40 pounds for a week. Is it really necessary to restrict activity, even lifting 100 pounds, with microincisional surgery? Or are we just trying to cover ourselves with these restrictions?
Mitchell Gossman, M.D.
St. Cloud, Minn.
Forty pounds for one patient may be a piece of cake or an impossible dream. I tell patients as long as they do not close their mouth and grunt, they may resume activities or weight lifting. They seem to understand this, and it is the valsalva maneuver with increased IOP that I am concerned about.
J. E. “Jay” McDonald, M.D.
My point is that a properly constructed incision should become stronger with a higher IOP and remain secure (a tautological definition, I understand that). So after day one, if the incision looks normal, I see little point in restrictions. I have no doubt that patients generate impressive IOPs transiently with bowel movements, sexual activity, eye rubbing, lifting, and so on. It’s a miracle that we don’t see flat 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 little healing going on.
Of course, a restriction of no lifting greater than 40 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 Optics, AMO, Santa Ana, Calif.), etc., I don’t place restrictions on them. I ask them to wear 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. However, I am much more 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 those who receive other IOLs?
Jeffrey Horn, M.D.
Our patients are instructed to —Discontinue eye makeup one week before any eye 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 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 (M.D., Rockville Centre, 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 eye makeup more completely than competing products or eyelid scrubs with baby shampoo. I usually point out to patients who balk at stopping eye makeup that they really do not want makeup particles under the LASIK flap or inside the eye. After surgery, I recommend no eye makeup for two 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 film is instructed to be sure that her (it is usually, but not always, a female patient) mascara does not promise to lengthen or thicken lashes, as products that do so contain fibers that flake off and fall into the tear film. Many companies, including Neutrogena and Clinique, offer a “gel mascara.” Patients are also cautioned not to apply cosmetics, particularly eyeliner, beyond the mucocutaneous junction of the lid margin. We tell them, “Apply to your skin only, not inside beyond the lashes.” We also recommend that they close their eyes when applying loose face powder. Patients generally are pleased to have their persistent foreign body sensation cured.
Anita Nevyas-Wallace, M.D. Bala Cynwyd, Pa.
I use atropine at the end of surgery, and on day five, if the pupil reacts, I add another drop. My only restriction is no reading without readers for two weeks. We give them the readers after surgery.
Ray Oyakawa, M.D. Torrance Calif.
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ABOUT THE AUTHOR
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