Important Note
These instructions are intended for Dr. Samer Hajjo’s patients. They may be used as general guidance for any patient undergoing strabismus surgery, or a parent of a child scheduled for surgery. However, instructions can vary between surgeons and can differ from one patient to another. You must follow the specific instructions provided directly by your surgeon and/or the hospital. Neither the website nor Dr. Samer Hajjo accepts responsibility for any non-compliance with the treating physician’s instructions.
Pre-Operative Instructions
Strictly avoid food, drinks, and smoking before surgery:
- Adults: 8 hours
- Children: 6 hours
- Infants: 3 hours
For all ages, a small sip of water is allowed up to 3 hours before the surgery time.
It is preferable to take a warm shower on the evening before surgery.
For women: do not use any makeup on the day of surgery, and remove any previous makeup traces on the evening before surgery. Also remove nail polish, as it may interfere with monitoring pulse and blood oxygen levels (the sensor is placed on the finger during anesthesia).
Inform the doctor about any previous or current medical conditions, any medications you are taking, and any allergies.
There are no restrictions on clothing because you will be provided with operating-room attire before entering.
Arrive at the hospital at least 1 hour before the scheduled surgery time.
Please note that the stated surgery time is approximate and may change depending on operating-room circumstances and preceding procedures.
Regardless of the patient’s age, at least one adult companion must be present.
Required laboratory tests before surgery vary depending on the patient’s age, the anesthetist’s assessment, and the hospital’s protocols.
Instructions for the First 24 Hours After Surgery
· Average hospital stay after surgery is about 2 hours (sometimes discharge is possible after 1 hour if recovery is good). Do not leave the hospital while the patient is still asleep; wake the patient, speak with him, and ensure he is fully awake before discharge.
· Continue complete fasting from food and drink for at least 2–3 hours after surgery, then progress gradually as follows:
1. Start with a small amount of water about 2.5 hours after surgery. It is acceptable to delay longer if the patient is asleep.
2. After 30 minutes from drinking water, if there is no vomiting, give a non-acidic, non-carbonated fruit juice in moderate amounts, gradually
over 2–3 hours.
3. After 1 hour from giving fruit juice, if there is no vomiting, the patient may take regular food, preferably low-fat and easy to digest.
4. If vomiting occurs, delay foods as much as possible.
· Vomiting is more common after strabismus surgery in the first hours compared with many other procedures. Some individuals are more prone to post-operative vomiting than others. In general, vomiting can be reduced by:
· Avoiding excessive and rapid movement during the first hours after surgery.
· Delaying eating and drinking after surgery; avoid large amounts at once; avoid hard-to digest foods.
· Appropriate pain control.
· Some pain on the day of
surgery and the following day is expected. The hospital typically provides
appropriate pain medication. After returning home, most patients do not need pain relievers for more than 1–2 days.
· Many patients cannot open the eye (or both eyes) normally on the day of surgery, and a smaller proportion even on the next day. This may be due to pain, swelling, light sensitivity, or discomfort with eyelid movement.
· Regarding eye patching: there are pros and cons. Dr. Samer Hajjo generally prefers not to patch the eye after surgery, with the following guidance:
· Closely monitor the patient during awakening and in the first hours after surgery to prevent touching or rubbing the eye.
· Gently wipe any blood-tinged discharge externally using a clean tissue or sterile gauze. Clean it promptly; do not wait until it dries, as it becomes harder and more painful
to remove.
· A patch may be used if the surgery was long and painful, or if a child is severely agitated and cannot be controlled. Preferably, the patch should not remain for more than 3 hours and
should be applied to one eye only.
· If the patient used glasses before surgery, resume wearing them immediately on the day of surgery or the next day, unless instructed otherwise.
· If secretions or clots stick to the eyelids/eyelashes and prevent opening the eye—especially on waking on the day after surgery or after removing a patch—clean gently using sterile gauze with saline, or sterile water (boiled then cooled), or artificial tears. Wipe the eyelashes gently.
Instructions for the First Month After Surgery
· During the first month after surgery (especially the first week), avoid exposure—when possible—to outdoor factors (sunlight, dust, pollution) and to substances/odors that trigger allergies, especially smoke of all kinds.
· Normal room lighting and watching television (within reasonable limits) are acceptable. Computer and mobile-phone use should be limited to necessity only.
· Avoid direct touching of the eyes as much as possible. Maintain good hand hygiene and general body cleanliness.
· Showering after surgery is not dangerous and does not directly affect the surgical outcome, but it can increase redness and congestion and delay their resolution due to hot water and irritation from soap entering the eye. Showering is possible even the next day, but keep the water temperature moderate, use baby shampoo (even for adults), and avoid getting it into the eye as much as possible.
· Time off school is usually about 1 week and may extend to 2 weeks in some cases.
· Time off work depends on the type of work and the surgery (one eye vs both eyes and the number of muscles operated on). It may be as short as 5 days for a simple, one-eye surgery when the job does not involve exposure to pollution/weather factors and does not require intense visual concentration. It may extend up to 1 month if multiple muscles were operated on and the occupation involves heavy exposure (e.g., bakery/oven work or construction).
· There is no fixed timing for the first post-operative examination: it may be the day after surgery or up to two weeks later, depending on the patient’s age and individual circumstances.
· Light sports can usually be resumed after 2 weeks; avoid contact/violent sports for 1 month.
· Swimming: avoid for at least 3 weeks.
Common Post-Operative Symptoms: What Is Expected vs When to Contact Your Doctor
|
Symptom |
Usually expected / normal |
Contact your doctor / seek review if |
|
Pain |
Moderate and improves with painkillers; does not last more than 2 days. |
Significant pain persisting beyond 2 days. |
|
Redness / congestion of the eye |
Moderate to severe in the first week; moderate to mild in the following 3 weeks; absent or very mild in the months thereafter. |
Severe redness persisting after the first week; noticeable redness persisting after 1 month; or severe conjunctival swelling (chemosis). |
|
Eyelid swelling |
Mild to moderate eyelid swelling during the first week. |
Severe swelling persisting for more than 2 days; or swelling with redness and marked tenderness on touch. |
|
Blood patches on the white of the eye (subconjunctival hemorrhage) |
Not dangerous and usually resolves within about 2 weeks, but may sometimes last up to 1 month. |
|
|
Tearing |
In the hours after surgery, tearing may be blood-tinged. Mild tearing may continue for 2–3 weeks. |
Severe tearing after more than 2 days. |
|
Discharge |
Mild discharge, usually noticed in the morning only. |
Heavy discharge persisting during the day, or new sudden morning discharge after a period of improvement. |
|
Foreign-body sensation |
Common in the first week. It may recur around the third week as the sutures start to dissolve. |
If the sensation increases and becomes very bothersome despite several days having passed. |
|
Blurred vision |
Mild blurred vision in the first days due to tearing and swelling. |
Significant and persistent blurred vision. |