Eye Plastic Surgery: During and Immediate post COVID-19 era

COVID-19 has brought the world to a standstill. Multiple lockdowns and there does not seem to be an end to it in the near future.

There is growing confusion and concern among patients as to what surgery can and cannot be done. Do we get a COVID – 19 test prior to surgeries? Why are doctors refusing to do certain surgeries, while continuing to do others? Now there are certain facts that we must understand.

Why we are deferring surgeries that will keep our practice up? The reason is simple, once the patient undergoes any surgery, his immune system becomes weak. Suppose you had an infection which is not showing symptoms, this weakened immune system can cause the symptoms to show up, needing further hospitalization and development of possible complications. Also, most of the ophthalmic plastic surgery takes place under general anesthesia, which further increases the risk.

Eye Plastic Surgery includes all surgeries associated with watering of the eyes due to blockage in the tear pathway, surgeries for eye cancer, surgeries where a prosthetic eye or a false eye has been placed, surgeries that involve the region behind the eye (Orbit), beauty enhancing procedures around the eye (aesthetic procedures), orbital fracture repairs (fractures around the eye), tears involving the eyelid and area around the eyes and many more.

Do we need a COVID-19 test prior to surgeries?

Let us keep the doctor’s opinion first on the necessity of COVID-19 test prior to a said procedure, and not listen to the media. If the doctor gets infected, imagine the number of patients who will eventually get infected due to exposure to the doctor in the period where he/she is not showing signs of infection.

So if the doctor asks for a COVID – 19 test, it is to safeguard you and the other patients as well as himself/herself from the threat. This will go a long way to curb the infection rate.

Watering from eyes

If the watering from the eyes is due to blockage in the tear drainage pipe, and is not infected i.e there is no acute pain, then the surgery can wait.

Remember this surgery deals with creating a passage into the nose – which is the most infected area as far as COVID -19 infection is concerned.

Plus after surgery, there is going to be breathing issues and decreased immune response, which will make you more vulnerable to catch the infection.

However, if there is an emergency – i.e there is pain, swelling, discharge, then the doctor will go ahead with the surgical procedure after taking all precautions. The nature of the emergency and appropriate intervention would be decided by the doctor.

Watering in small kids can be managed with lacrimal sac massage till it becomes safer to operate and give general anaesthesia. Again all said, if a situation arises which is an emergency, the child may be taken up for the procedure.

Eye Cancer

Eye cancer is definitely an emergency, and will be treated. Anyone suffering from any form of eye cancer, will be given appropriate treatment with all necessary precautions.

Trauma or injury around the eyes

Injuries in and around the eyes classify as emergency and will be dealt with as early as possible.

Fractures around the eyes, however, will depend on whether this procedure is an emergency or can wait, involvement of other bones and structures around the eyes. This will be at the discretion of the treating surgeon.

Sockets using false eyes or prosthetic eyes

Routine care with lubricating eyedrops should suffice for most cases. Where there is no acute infection, the surgery can be deferred for the time being and can be taken up when it becomes safer and the number of cases are on a decline.

Aesthetic procedures around the eye

As these procedures are not an emergency, we can safely defer it. This will stop you being exposed to the patients and doctors in a public workplace setting and so will help the doctors and the hospital staff in case anyone is not showing symptoms now but is infected.

We have to wait and have patience till we develop either an effective treatment, or a potential vaccine or develop ‘herd immunity’ to call it safe. Till then we have to do the best we can to protect ourselves and our near and dear ones.

Nandini Bothra
Consultant, Govindram Seksaria Institute of Dacryology,
Ophthalmic Plastic Surgery Services,
L V Prasad Eye Institute, Hyderabad.
Email id: nan_bothra@yahoo.com