What it is like having glaucoma and then eyelid surgery, a patient’s perspective
In this blog post, I interview Kirsty who is registered severely visually impaired from glaucoma and cataract. She has done amazingly well after numerous intra-ocular eye surgeries and works as a teacher. I want to know about her experience of having glaucoma, cataracts and then eyelid surgery. She looks so normal, and no one can tell that she has had several operations in each eye and also recent eyelid surgeries for ptosis.
Jane Olver: Hi Kirsty. How old are you?
Kirsty: I’ll be 28 next week.
Jane Olver: Tell us a little bit about what you have been through with your glaucoma?
Kirsty: I was diagnosed with glaucoma when I was 13, and I had trabeculectomies in both eyes then a bleb revision, cataracts removed in both eyes, and lots of different eyedrops, and I am now off all eye drops
Jane Olver: And you can see very well, can you?
Kirsty: Yes, and no. I am registered severely visually impaired (blind).
Jane Olver: But you do not look remotely so!
Kirsty: But I have good central visual acuity in my left eye and still can see well down the chart. But my peripheral visual field is really damaged.
Jane Olver: Unfortunately, the glaucoma you developed when you were teenager damaged your visual fields quite badly. By the time it was discovered, the optic nerve was by then quite damaged.
Kirsty: Yes, nobody was expecting me to have glaucoma, and I seemed to see well.
Jane Olver: Did your glaucoma run in the family?
Kirsty: It does not, no.
Jane Olver: So how was it picked up?
Kirsty: I was getting really bad headaches. I read quite a lot as a child but I was struggling to read so we went to the optician.
Jane Olver: And what were the eye pressures?
Kirsty: Around 38, I think. The high pressure caused the headaches and blurred vision.
Jane Olver: That is quite high because the normal is 10 to 20. Do you know what type of glaucoma you had?
Kirsty: Open-angle glaucoma. It needed eye surgery, then I got cataracts, and they needed to be removed too, so I have intra-ocular lenses.
Jane Olver: You seem a very normal and cheerful young lady who looks as if you have normal vision. You work as a teacher, and apart from your left upper eyelid which developed a ptosis after all the eye surgery, your eyes themselves looked great. Drooping eyelids (Ptosis) can occur after eye surgery but can be fixed.
Comment: Kirsty is aged 28 years old and teaches teenagers and so it is very important that she looks normal. The group that she teaches are aged 14 to 17 years so they are very conscious of appearance. As a teacher, she wants to have eyes that look normal and symmetrical in front of her students. Also because she has had all the problems with glaucoma and cataract it is very important to her personally that she has eyes that look, to everybody else, as though they are normal. Kirsty alone knows that she has had glaucoma and cataract and that she has the trabeculectomy blebs and that she is not got a full visual field, so this makes it doubly important that she has a good result from her eyelid surgery. We talk about the positive impact ptosis surgery had on her.
Jane Olver: Your glaucoma is now under excellent control after your eye drainage surgeries (trabeculectomies) and you came to see me recently this year because the eyelid was drooping on the right side?
How long has it been drooping? Tell me about the eyelid.
Kirsty: I think I first noticed it had started to droop about five years ago, but it was not very severe. For the last two or three years, it could be quite severe especially when I was tired.
Jane Olver: Did other people comment on it?
Kirsty: No. But if I asked people they would say, yes, that they could see it. It was more that I noticed it, I think. I had ptosis surgery on my left upper eyelid, and it became too high and staring so I am not happy with its look. It was too high.
Jane Olver: And then when I did the surgery a month ago to lower it. This is called reverse ptosis surgery as your eyelid was retracted and it had a double skin crease so looked very different from the other side.
Jane Olver: I also got rid of a double crease. You look so normal now. You look tremendous!
Kirsty: Yeah, I am really pleased.
Jane Olver: That’s great. That is fantastic. How many weeks did you say you are postop now?
Kirsty: Four weeks tomorrow.
Jane Olver: Four weeks tomorrow, and the eye is a little bit dry so I think you should still put in some lubricant drops such as Theoloz Duo, is that OK with you?
Jane Olver: What have other people said to you since you have had the surgery?
Kirsty: My husband and my mother-in-law have both said how fantastic they think it looks and they said that they could see a tremendous improvement from before the surgery.
Jane Olver: It looks so much more symmetrical.
And also your eyebrows are more symmetrical.
The lid show is symmetrical. Colour is great.
I had to get you to look down just now so that I could see the skin crease to remember to be absolutely sure which eyelid I had operated on.
Kirsty: That’s good!
Jane Olver: I find that with young people that from two weeks onwards you very often can hardly tell which eyelid they had operated on because you heal so well.
Kirsty: I am so pleased, I didn’t think I would get the result that we have actually. I feel so much happier already.
Jane Olver: What you do during the day?
Kirsty: I am an English teacher.
Jane Olver: What age group do you teach?
Kirsty: Secondary school, so year 7 to year 13. Having the eyelid surgery made a big difference because that age group are so aware of appearance.
I just feel a lot more confident now.
Jane Olver: Your eyelid height and curve is great, you look really natural. You are closing the eye fully now. You looked a little bit starey and high, to begin with, but I think you have been very effective in the treatment of lash pulling and it is really perfect now. However, the eyelid is a little sensitive and your eye is feeling a little bit dry because the eyelid is stiff and still needs a bit more time to recover. You should be putting in the lubricant drops probably two to four times a day up to eight times a day with Theoloz Duo.
Ask me questions about your eyelid.
Kirsty: Do you think the scar will flatten?
Jane Olver: The scar has its own natural history.
To begin with, it is very quiet when you have got the stitches and the glue. After we take the stitches and glue off the surface, gradually it gets a little bit redder and a little bit bumpier while it is healing with time. It goes through an itchy phase, then the itchy phase goes away and then gradually, the very slight and bumpiness that is will diminish because the scar remodels. So the little blood vessels that are making the eyelid look pinker are taking in cells to remodel the scar tissue inside. Remember you had an awful lot of scar tissue at surgery which we excised.
I am amazed that you do not look more inflamed now, that you barely look inflamed at all. There is only very slight pinkness which one can detect.
With time the scar diminishes.
There is an internal healing.
The scar is really a term that refers to internal healing and skin healing, and it remodels and becomes softer, and it is then really not a scar, it is healed.
Kirsty: Yeah. I can feel the difference between today and the first day
Jane Olver: And thank you for letting me interview you for the blog. I am sure it will help other people