Anaesthesia options for eye lid and lacrimal surgery

The options for anaesthesia for eyelid operations are:

  • local anaesthetic without sedation

  • local anaesthetic with sedation

  • general anaesthetic

Each anaesthetic has different risks, advantages and disadvantages. These are summarised below:

Local anaesthetic (LA)

Most patients having eye lid surgery will have this under local anaesthetic. This initially involves eye drops into both eyes and then the injection of an anaesthetic just under the skin in the area of to be operated on. The injection can be quite painful (a bit like a dental injection). I give it slowly and gently to try and reduce the amount of discomfort and then apply pressure to reduce any bruising due to the anaesthetic. The Local Anaesthetic will numb the area of the operation and then you will not feel pain during the procedure, although you may feel a little bit of pressure. If you do feel some pain, you must let me know and I will give you more anaesthetic. The sensation will return in about 2-3 hours and you may wish to take a painkiller such as paracetomol if there is any discomfort. The local anaesthetic (and the surgery) can cause bruising, which usually takes up to a week to resolve.

LA is the safest way of having an operation and the majority of my patients chose a local anaesthetic. There is a small risk of minor complications such as nausea, tremor, agitation or dizziness (about 1% risk for each of them). Most patients go home the same day of surgery (‘daycase’) and unlike sedation and general anaesthesia (see below) you usually do not require anyone to be at home with you on the first night after surgery.

 Sedation

 

An anaesthetic doctor will administer the sedation – most commonly by injection into a vein of a drug that will make you more relaxed and sleepy. The anaesthetist will monitor your heart and breathing as if you are having a general anaesthetic (see below). With sedation you will be asleep or very sleepy during the local anaesthetic injection, so that you do not feel the pain of the injection and may remain relaxed or sleepy during the rest of the operation . The precise amount of sedation that you are given can be decided by the anaesthetist and can range from being just a bit more relaxed than normal to being very sleepy throughout the operation.

Side effects and complications of sedation include headache (either during or afterwards), sore or dry throat and lips, nausea and rarely vomiting, faintness or dizziness, or drowsiness (about 1 in 3) afterwards especially when you start to move around after the operation.

Less common side effects and complications of sedation include general weakness and muscle aches and pains. Some people may develop a mild allergic itch or rash.

Very rare but serious complications include pneumonia (which can be caused from stomach contents being aspirated into the lungs during an episode of vomiting), epileptic seizures, blood clot in the lungs, severe allergic reactions (anaphylaxis), heart attack and stroke, which may cause death .

You can still go home the same day of surgery if you have sedation, but there are strict guidelines from the Royal College of Anaesthetists that should be adhered to:

  1. You have someone to pick you up from hospital

  2. You have someone at home with you the first night after surgery.

  3. You do not drive for 24hrs after the procedure.

  4. It is advisable not to make important decisions for 24hrs after the procedure and some people recommend not using Social Media for this period, as some people’s judgement can be affected by sedation.

  5. You must not operate machinery including home appliances for 24hrs after surgery

 

General Anaesthetic (GA)

A General anaesthetic means you are asleep or unconscious throughout the operation. The GA is administered by an anaesthetist who will monitor your heart and breathing throughout the operation. You will wake up after the procedure and you may need to stay in recovery for a few hours while you are being monitored.

There is a greater but still very small risk of serious complications with GA. These include teeth injuries while an instrument (laryngoscope) is inserted into your mouth (1 in 100), sore throat (which usually recovers within a few days), blindness (1 in 250,000) or even death (1 in 50,000, but even lower risk if you are healthy and higher risk if you have significant other medical conditions, e.g. of the heart, lungs or brain, or obesity).

The same advice as for sedation above must be followed after GA, i.e:

  1. You have someone to pick you up from hospital

  2. You have someone at home with you the first night after surgery .

  3. You do not drive for 24hrs after the procedure.

  4. It is advisable not to make important decisions for 24hrs after the procedure and some people recommend not using Social Media for this period, as some people’s judgement can be affected by sedation.

  5. You must not operate machinery including home appliances for 24hrs after surgery