A vitrectomy is a common ophthalmic procedure used to treat conditions like retinal detachment, macular holes, or vitreous hemorrhage. The surgery involves removing the vitreous humor, the clear, gel-like substance filling the eye’s center, to access the retina for repair. The vitreous is often replaced with a temporary substitute, such as a gas or silicone oil bubble, to aid healing. A successful outcome depends entirely on strict adherence to post-operative instructions.
Restrictions on Head and Body Positioning
Maintaining a precise head position is a specific post-operative requirement, especially after surgery for a macular hole or retinal detachment. If a gas or oil bubble (tamponade agent) was placed, it acts as an internal splint to hold the repaired retina in place. Since the bubble naturally floats, the patient must position their head so the bubble rises to press directly against the surgical repair site.
This often requires a “face-down” posture or a specific side-lying position. This posture ensures the bubble applies continuous pressure to the intended area, preventing the retinal tissue from shifting. Incorrect positioning allows the bubble to float away, which can cause the retinal problem to recur.
Patients must maintain this positioning almost constantly for the period determined by the surgeon, often several days to a week or more. Short breaks are permitted for meals or hygiene, but dedication is required, even while sleeping. Specialized equipment, such as face-down chairs or positioning pillows, can be rented to minimize strain and ensure compliance.
Activities That Increase Eye Pressure
Avoiding actions that cause a sudden spike in intraocular pressure (IOP) is necessary after a vitrectomy. The small surgical incisions require time to seal, and excessive internal pressure can compromise healing or the stability of the tamponade bubble. Straining or bearing down should be strictly avoided for several weeks.
This includes heavy lifting (over ten pounds) and strenuous physical exercise. These activities trigger the Valsalva maneuver, which dramatically increases pressure in the chest, abdomen, and eye. Bending over at the waist, especially to pick up objects, must also be avoided, as this movement causes a temporary surge in IOP.
Straining during a bowel movement can elevate internal pressure and should be prevented, often with stool softeners. Patients must also refrain from forcefully rubbing the operated eye, as this applies direct external pressure.
Environmental Exposure and Contamination Risks
Protecting the eye from external contaminants is important to mitigate the risk of post-operative infection, known as endophthalmitis. Avoiding environments and activities where the eye is exposed to dirty water or foreign particles is paramount during the initial healing phase.
Patients must avoid activities that expose the eye to water or debris:
- Swimming in pools, lakes, or oceans.
- Using hot tubs or saunas until cleared by the surgeon.
- Allowing tap water near the eye when showering or washing the face, as it can harbor microorganisms.
- Exposure to dusty or dirty environments, such as gardening or construction sites, where airborne debris carries infectious agents.
Wearing eye makeup, particularly mascara and eyeliner, is prohibited due to the risk of introducing bacteria near the healing incision sites. The surgeon will prescribe an eye shield to be worn, especially at night. Following the exact hygiene routine prescribed by the surgical team is necessary to maintain a sterile healing environment.
Travel and Altitude Limitations
A unique restriction for patients with a gas bubble is the prohibition of travel involving significant altitude changes. This applies to all forms of air travel and travel through high mountain passes, as the gas bubble is sensitive to atmospheric pressure changes.
When altitude increases, external pressure drops, causing the gas bubble inside the eye to expand rapidly. This expansion leads to a severe spike in intraocular pressure, risking permanent damage to the optic nerve and blood vessels and resulting in irreversible vision loss. Patients must wait until the gas bubble is completely absorbed (two to eight weeks, depending on the gas type) before flying.
Driving to destinations significantly higher than one’s home elevation should also be discussed with the surgeon. Silicone oil, sometimes used instead of gas, is not sensitive to altitude changes. However, oil requires a separate surgical procedure for removal later.
Symptoms Never to Ignore
While some post-operative discomfort and blurry vision are expected, certain symptoms signal a complication that must be reported to the surgeon immediately. Delaying contact with the medical team for these warning signs can jeopardize the surgical outcome and lead to permanent vision loss. Patients should never attempt to self-treat.
The most concerning symptoms require immediate professional evaluation:
- Sudden onset of severe, throbbing eye pain not relieved by medication.
- Sudden and significant decrease or total loss of vision.
- Appearance of new, numerous floaters, flashing lights, or a curtain-like shadow, which can indicate a new retinal detachment.
- Any sign of infection, such as increasing redness, excessive discharge, or pus draining from the eye.