When you hear that you have basal cell carcinoma on your eyelid it is scary. Let me jump to the end – my story has a happy ending. Whew! A few weeks ago I shared the beginning of my story with basal cell carcinoma on the lower eyelid. I’ll be honest, it was a scary procedure. And doubly scary because it was all performed on my eye! Spoiler alert – everything turned out fine and my eye looks great. Unless you’re uncomfortably close to my face, you’d never know that anything was done to my lower eyelid, let alone that more than a third of it was removed. In case you’re facing basal cell carcinoma on the lower eyelid, let me tell you all about my experience with the surgery and recovery.
About the time that I had my complicated appendectomy, I noticed a “stye” on my lower eyelid. I was busy healing from the apendectormy and so I didn’t worry much about the stye since I’ve had them before. A couple of months later, I had some unusual reactions associated with my stye that caused me to go to my family practice doctor. Two different doctors in the practice saw my stye and treated it as a “normal” stye. Finally I was referred me to an ophthalmologist. As soon as the ophthalmologist saw my stye, he suspected that it was basal cell carcinoma .
Let me start by stressing that I am not a physician and I have no medical expertise. I am only sharing my personal experience. You should consult with your physician for every aspect of your personal medical situation. As a layman, I use layman’s terms and not medical terminology.
Next let me stress do not google basal cell carcinoma images. Just don’t do it (ask me how I know). It won’t help. Reading about it and talking with your physician is more than enough. I’ve spoken to another woman, that has recently gone through this same surgery. She did google the images and said she cried after seeing those images and wished that she hadn’t seen them. However, she did feel that it helped prepare her when her doctor showed her images of her own eye during the surgical process. I’d prefer to simply ask not to see the images of my eye and to not google them (you can’t unsee them).
Basal Cell Carcinoma on the Lower Eyelid – Surgery and Recovery
My surgery was done in two steps. The Mohs surgery removal of the basal cell carcinoma and then the reconstruction surgery.
Mohs Surgery – is the process that removes the basal cell carcinoma. It’s a balancing act between removing enough to get all the cancer and have clear margins (which means edges with no cancer cells) and not taking too much extra skin. My Mohs surgery was performed by a dermatologist. I was seated in a large padded chair, much like a dentist chair, and alert the entire procedure.
The Mohs surgery was similar to the biopsy when it came to the pain level. I was given the same numbing shot in my lower eyelid that I described in my part one of basal cell carcinoma on the lower eyelid. Because it’s a local anesthesia, I was totally wide awake for the procedure.
I requested the same shield to cover my eyeball that I had for my biopsy. It’s almost like a sunglasses lens that is placed over your eyeball. It was slightly uncomfortable physically, but gave me psychological peace during the process. Truly the worst part of the procedure is the fact that it’s all done on your eye! The physical pain and discomfort is tolerable, it’s the psychological stress that was most difficult for me. The protective lens made the process a bit easier.
After my eyelid was numbed, the dermatologist removed a “U” shaped piece of my lower eyelid. Although the surgery was done on my eyelid, I couldn’t really see what was happening. The bright lights obscured details and everything was too close to my eyes for me to be able to focus on it. I could see general movement and shadows, but no details (and that was probably a very good thing!).
The specimen that had been removed was then taken to the lab to make sure that the margins were clear. I sat and waited in the procedure room until the results came back. It took approximately 30 to 40 minutes to find out the results. The margins were not clear so the doctor performed the procedure a second time. Again, I sat and wait until the lab examined the margins of the sample. I was told that on average it takes 3 to 4 tries before they obtain clear margins, but can take more. I was fortunate that it only took two times for me to obtain clear margins.
Once we were notified of the clear margins, the nurse placed a bandage over my lower eyelid and I was released to go to the outpatient procedure area for the reconstruction surgery.
Eyelid Reconstruction Surgery – once the carcinoma was removed, the gap needed to be closed so that my eyelid will function properly and look correct. My reconstruction surgery was performed by an ocuoplastic surgeon (an ophthalmologist that specializes in plastic surgery involving the eye).
The reconstruction required general anesthesia. At the military hospital where my surgeries were performed, there was a 4-hour wait before my reconstruction surgery. That was tough because the bandage on my lower eyelid was extremely uncomfortable. The tape was poking into my eye every time I blinked. Yes, go ahead and say, “Just don’t blink” and then you try not to blink for 4 hours. Once we figured out the tape was causing the discomfort, the nurse simple removed the bandage and I felt much better.
I had been told that there were three options for the reconstructive surgery. The ocuoplastic surgeon wouldn’t know which procedure would be needed until she saw how much of my eyelid had been removed. The three options I was told about were:
Let me remind you that I am not a medical professional, this is my layman’s understanding of the procedures.
- First Level – Simply pull the edges of the gap closed. This would be the option if only a minimal portion of my eyelid was removed.
- Second Level – The edges of the opening would be pulled together and closed. But if the gap was larger than in the first level option and they simply pulled the edges together, the eyelid would flip inside out as it healed. To prevent that, my lower eyelid would be sewn shut to hold it in place while it healed for one week.
- Third Level – If the gap was too large to be pulled together, it would require a skin graft. For details, ask your doctor if this option may apply to you. I will tell you that it involved having your eye sewn shut for several weeks.
Before you get too upset about these options, you don’t really have a choice. You must remove the basal cell carcinoma. It will only continue to grow. If you remove it now, with clear margins, you will be fine. However, if you don’t remove it, it will continue to grow and create an even more complicated surgery and reconstruction process later.
When I woke up from the surgery I found out that I had needed the second level reconstruction. I really couldn’t feel anything. My eye was bandaged and I was groggy. I went home that evening. I don’t think I even took aspirin or a pain reliever. I simply went to bed early.
I was told to leave the bandage on until the next day (and goodness knows that was fine with me). I was nervous about seeing my eye (who wouldn’t be?!) But by the next day, I was ready to take that bandage off because it was itchy and uncomfortable. As much as I wanted to remove the bandage, I was still really nervous to see what my eyelid looked like.
I’ll be honest. It was a bit startling, but not because of any incisions, stitches or ghoulish stuff. I actually could barely see the incision and stitches because my upper eyelid was sewn shut and my upper eyelashes covered the incision. What was startling was that there was a small white pad with a knot in the middle of it on my upper lid. As I understand it, there were long threads of stitches from my lower lid up through my upper lid and tied off on my upper lid (all underneath my eyelid except for the small knot on top of the pad). This held the lower lid in place and in shape so that as it healed it didn’t turn inside out. The pad was to prevent the tied stitches from tearing through my upper lid. Once I got over being startled by the square pad, it was not at all ghoulish, just surprising.
I kept the area moist with the ointment I was given. It helped keep both the upper and lower eyelid more comfortable during the healing process.
Now let me be honest – the healing process was very uncomfortable. It was not painful, but was uncomfortable and tedious. The discomfort was caused by:
- My lower eyelid felt sore as it was healing. Again, let me stress it was not painful, just very sore, like a deep bruise.
- My upper eyelid was also sore by the end of the second day. It was sore because the threads holding the lower lid shut to the upper lid pulled on the center of my eyelid. You can imagine how delicate your upper eyelid is when something it tugging on it 24-7. Again, not painful, but a soreness that got stronger as each day went by. It felt like I’d been beaten up (or what I imagine it feels like to be beaten up).
- I felt discomfort on my eyeball from the stitches. It felt like a piece of twine was running under my eyelids. This sensation apparently were the stitches holding the lower lid to the upper lid. Each time I moved my good eye, my sewn shut eye moved with it, of course. Over time it felt like a piece of rough twine was rubbing across my sewn shut eyeball. It was extremely irritating. No damage was done to my sewn shut eyeball, but I did wonder at the time what all that irritation was doing to my eyeball.
Tips for When Your Eye Is Sewn Shut
- Small bags of frozen peas will be your best friend. I bought a large bag of frozen peas and split it up into about 8 snack size zippered plastic bags. The peas molded comfortably to the contours of my eye socket. Please be sure to check with your physician before using ice packs on your surgical site. Using the ice packs reduced swelling (I really didn’t have much swelling) and made the soreness and irritation feel a better. I simply rotated my 8 bags of peas so that there was always a frozen bag ready to use. I can’t stress how much the frozen pea ice packs helped with the discomfort.
- Keep both eyes closed as much as you can. Although I could certainly use my good eye to whatever I felt up to, I found it most comfortable to keep both eyes shut much of the time.
- By keeping both eyes shut, it prevented the sewn shut eye from moving with my good eye and becoming more irritated by the twine like stitches rubbing across my eyeball. That meant lots of naps and laying still with my eyes closed.
- Keeping both eyes shut also reduced the pulling on my sewn shut upper eyelid. Every time I opened my good eye, my sewn shut eyelid tried to open instinctively. That tugged on the stitches and the pad holding my upper lid closed and over time that became very sore. Then every time I opened my good eye, the tugging on my sore sewn shut eyelid hurt more. Eventually, I just tried to keep both eyes shut as much as I could.
- Lay with your head raised. I slept with an extra pillow. This seemed to help reduce the swelling and resulting pressure. Please check with your physician first.
- Only open your good eye part way and peek out the bottom of your eye. When I did need to open my good eye, I only opened it slightly, lifted my head up and peeked out of the bottom of my eye. This minimized the discomfort from the tugging on my sewn shut eyelid and my sewn shut eyeball rubbing under those stitches. I was able to see enough to walk around the house, eat, shower, etc, but it was not very comfortable to watch T.V. Watching videos on a tablet was a bit better.
- Get books on tape or have someone read to you. Because it was more comfortable to keep my eyes closed and because a week is a long time to live with your eyes closed, my sweet daughter read to me aloud. Alot! It was wonderful to share that time with her, but I wished that I had gotten a bunch of books on tape so that she got a bit of a break and I wasn’t going stir-crazy when she couldn’t read to me (darn school and homework!).
One Week After Surgery
One long week later, I went back to the doctor’s office to have my eye opened. I was nervous because, well, it’s my eye! and it was very sore after the surgery and being sewn shut. But it took seconds for the doctor to snip the stitches and didn’t hurt at all. I was a bit scared to open my eye, but it opened just like normal and worked perfectly. In that opening and the next couple of blinks it was almost like the past week had never happened. Then the doctor handed me a mirror and my eye looked perfect. The upper and lower lid were a bit bruised and I had black stitches on my lower lid (it looked kinda like Alice Cooper eye make-up), but my lower eyelid looked perfect! And it worked perfectly! Within seconds if felt almost normal again.
I was mildly bruised for a couple of weeks. But given what my eye had been through, the bruising was really nothing. This photo is three weeks after my surgery.
Stitches – I had internal stitches left in my lower eyelid. One of my stitches made it’s way out through my eyelid. My doctor told me this was unusual, but does happen. It wasn’t painful, just a bit startling. It looked like a hairbrush bristle coming out of the edge of my lower eyelid. It ended up just falling right out. No big deal.
My doctor advised me to gently massage the scar a few weeks after the surgery. Please check with your physician before you do anything involving your incision or scar. As I understand it, this helped prevent scar tissue from building up (you know how sometimes a scar creates a ridge once it heals). I can tell you that there is no scar at all visible on my eyelid. There is a tiny divot on the edge of my eyelid. But you have to get uncomfortably close and know exactly where to look to notice it. I’m telling you, my eyelid looks amazing! My doctor did an amazing job of reconstructing my lower eyelid (remember, that at least 1/3 of my lower lid was removed!) I keep telling my ocuoplasty doctor that she did such an amazing job that I want her to handle all my medical care now.
Eyelashes – The one thing that I continue to deal with is eyelashes growing in wonky on my lower eyelid. Because the edges of my eyelid had to be pulled together to reconstruct my eyelid, some of my eyelashes have been growing in at an angle that pokes into my eyeball. Yes, it’s highly uncomfortable. I can ignore the discomfort until about 2 p.m. and then the cumulative discomfort makes me very cranky.
The first time the eyelashes grew in, the doctor simply plucked them out. This was surprisingly painless. I was cringing, anticipating the zing that I feel when I pluck my eyebrows, but there was no pain at all. Really. As I understand it, this works for some people and is all they need to get rid of the wonky eyelashes. Apparently, I have stubborn eyelashes. They continued to grow in. The next step was eyelash ablation by electrolysis. The electrolysis did not hurt at all, but that’s because I had the same local anesthesia that I had for the biopsy. The numbing shot is the worst part, by far. Apparently, I have really stubborn eyelashes because I’ve had this electrolysis process three times. But having eyelash constantly poking in my eye is not an option, so I’ll go back as many times as necessary.
If you are facing basal cell carcinoma on the lower eyelid surgery and recovery, know that you will make it through. I’m being honest with you, it is difficult psychologically. It’s tough because it is your eye! But the pain level is not high. The only pain I had in the entire process is the pain from the local anesthesia injection. There was discomfort and soreness, but very little sharp, piercing pain. And the happy ending is that my eye looks 99% perfect and I no longer have basal cell carcinoma on my lower eyelid.