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This vitrectomy resource page has been put together to help you understand why patients need to stay face down during their vitrectomy recovery, and how to make this period of face down posturing as comfortable and stress free as possible.
Some of the conditions requiring patients to have Vitrectomy surgery include:
The amount of time the patient will need to spend with their face down to allow the eye to heal will vary depending on their personal prognosis. For detached retinas, the patient will often be required to be face down for 3-4 weeks. For macular holes, a one week posturing (face down) period is common. Whatever the prognosis, it is important the patient closely follows the instructions given by their doctor. However, there are some guidelines that will help you in a vitrectomy recovery regardless of the cause of the eye trauma. To begin, it is helpful to understand why staying face down is important to the vitrectomy recovery process.
Common Causes of Retinal Tears & Detachments
The most common reasons for a vitrectomy requiring the patient to stay face down during the recovery period are retinal detachment and macular holes. The predominant cause of both these conditions is the shrinking of the vitreous gel which fills the center of the eye. (In younger patients the most common cause of detached retinas is physical trauma. Diabetes is also a contributing factor.) As people age, the jelly-like vitreous body that fills the eye can harden, shrink and become fibrous. If the vitreous substance has bonded to the retina at the back of the eye, it can cause tearing as it pulls inward. The retina in the eye is like the film in a camera; it is where the image we see is captured. When these retinal tears occur, they will often be accompanied by the sensation of seeing sparks, cloudiness, or floating objects in the visual field. If fluid from the eye gets behind the retinal tear, it can cause the whole retina to detach, causing total loss of vision. Even if the retinal tear does not cause retinal detachment, it can lead to serious loss of vision if it occurs in the center of the retina (or macula) which captures the detailed part of the visual field (as opposed to our peripheral vision which is less detailed.) A retinal tear in the macula is often referred to as a macular hole.
How a Vitrectomy Helps Heal the Eye
During a vitrectomy, the surgeon will remove part of the vitreous substance to prevent it from tearing or pulling the retina any further. Most of the time, an air bubble is inserted to take the place of the removed vitreous substance after surgery. When post surgery vitrectomy patients keep their face down, the air bubble rises to the back of the eye, where it presses the retina flat so it can heal. Holding this position is sometimes referred to as posturing. Vitrectomy recovery equipment such as that rented by FaceDown Rental makes posturing comfortable for the patient.
Why Staying Face Down is Important
When the head is upright, the air bubble will move to the anterior (top) part of the eye which can leave the retinal tear or detachment exposed to further pulling and irritation from the vitreous gel and eye fluids, preventing healing. Anterior movement of the air bubble within the eye can also accelerate cataract formation, raise intraocular pressure and damage the cornea. As the retina heals and re-bonds to the wall of the eye (usually a period between one week and several weeks), the gas bubble will begin to diffuse and the body's natural eye fluids will fill the space. When patients using proper vitrectomy recovery equipment are able to stay face down during the entire recovery period, the success rate of this operation in repairing the eye and restoring vision is near 90%.
The main keys to a comfortable and successful vitrectomy recovery are:
During the vitrectomy recovery period, the patient will have limited mobility, so it is important to get everything they will need prepared ahead of time:
After vitrectomy surgery, the patient may experience swelling and bruising around the eye. The patient may feel pressure within the eye initially. There will likely be pain. The doctor will help the patient to regulate their pain, which is important because uncontrolled pain can hinder the immune system and slow healing. The post operative eye is likely to tear up regularly, so it helps to place boxes of tissues in reach of the patient's vitrectomy recovery chair, bed, and anywhere else they will be spending time.
Vision will likely be blurry while the air bubble is at its full size. As the bubble dissipates, vision will gradually improve. Redness in the eye is common. Any deep, throbbing pain which does not respond to the pain relief your doctor has recommended for you should be reported. The vitrectomy patient is prohibited from flying or traveling to high altitudes until the gas bubble has been completely dissipated - in high altitudes the air bubble will expand, creating a variety of health risks to the eye.
Other vitrectomy side effects may include changes in smell, taste, noise tolerance and depth perception. There may be side effects from pain medication as well. Some of these changes effect the patient's ability to perceive and navigate around obstacles, so that is why it is important to keep the area as clear as possible.
The vitrectomy patient's daily routine will be much more manageable with the help of friends and family members. This is a time to rely on loved ones as much as possible. Below are some tips for managing daily activities. In general, always ask the doctor what is best, and get the vitrectomy recovery patient as much help as possible.
Many people find it easier to take a bath than a shower while keeping their head down. Move the soap, shampoo and any other bathroom necessities to a low spot where they will be easily reachable.
The vitrectomy recovery patient should wear button up shirts (as opposed to shirts which must slip over the head). Clothes that are easy to slip on and off like pajamas, sweat pants, and bath robes will make life easier.
The patient's sleep schedule is likely to change during the period of their vitrectomy recovery. Sleeping face down is unfamiliar to most people, and will take a little getting used to. It is often easier for the patient to wait until they are extremely tired and already falling asleep before they attempt to "go to bed". Keep tissues nearby in case of eye tearing. Make sure the patient is as comfortable as possible, with proper bedding, room temperature, and of course the FaceDown Rental Sleep Support.
Eating and Drinking
Swallowing will be easier if the patient is bending more from the waist than from the neck. All drinking should be done through a straw. A TV tray or other low table may be useful for setting the food on. The patient may prefer softer foods which are easier to swallow. If there is medication which must be taken orally, it may help to break pills or dissolve them in food. Another alternative is to find a compounding pharmacy who can prepare the medication in an easier to administer format.