Basal Cell Carcinoma on the Lower Eyelid

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Who knew you could develop basal cell carcinoma on the lower eyelid? I didn’t. I grew up in Hawai’i spending hours and hours in the sun every single day and that was before anyone wore sunscreen. We just didn’t know and it was considered wimpy to wear sunscreen. Now I certainly wish I’d worn sunscreen and sunglasses for all those years living in sunny paradise. As a result of all that sun exposure, I developed basal cell on the lower eyelid which resulted in surgery to remove it and then reconstructive ocuoplasty surgery to repair my eyelid.  In case you ever have the same experience, I want to share what I’ve learned and wish I’d known before I had my surgery.

This has been quite some year for me. I’d never been under general anesthesia before but went under it twice in six months. The first time was for an emergency appendectomy last fall and then again this spring to remove basal cell on the lower eyelid. I’m generally a very private person. I’d rather not tell you about this experience, but I hope that this information may help someone else facing this experience. 

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. 

My experience started around the same time as my appendectomy. Around that time, I noticed a stye on my lower eyelid (spoiler alert – it wasn’t a stye!). I get styes once in a while so I didn’t think much of it. Then I was kept busy with recovering from my appendectomy at home, so I didn’t think much about my stye. 

Finally 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 because I’d had it for four months,  my family practice doctor referred me to the ophthalmologist. As soon as the ophthalmologist saw my stye, he suspected that it was basal cell carcinoma. The fact that I grew up in sunny Hawai’i backed up his suspicions.

I hope you never have to experience basal cell carcinoma on the lower eyelid. Be sure to wear your sunscreen and sunglasses every single time you go outside. 

Basal Cell Carcinoma on the Lower Eyelid

These observations are mine and use layman’s terms. These do not represent medical information. 

Basal cell carcinoma often occurs on eyelids, especially the lower lid. Think about it. Even if you put sunscreen on, you don’t put it on your eyelids up to the edge. I want to show you this photo of what my basal cell carcinoma on my lower eyelid looked like so you’ll know to have your doctor check out a stye-that’s-not-a-stye if you ever have one. 

If basal cell carcinoma is suspected, they will do a biopsy.  In a way this is the worst part of the entire surgery experience because you don’t know what to expect and it’s on your eye! After going through the biopsy, you’ll know what to expect with the surgery, if it’s necessary. My biopsy was done as an outpatient procedure with local anesthesia.

I laid on my back on a table. The doctor placed a drape over my head with an opening that exposed my eye. That was disconcerting; a bit too much like a burial shroud for my liking. But the drape was helpful because then I couldn’t see what was being done on my lower eyelid. The procedure room had bright lights and that also helped prevent me from seeing what was about to happen.

The doctor gave me a numbing shot in my lower eyelid. That was the most painful part. The worst part of it was knowing that it was near my eye. If I’d had the same shot somewhere else on my body, it wouldn’t have been that big of a deal. After the local anesthesia, the rest of the process was tough psychologically, but not physiologically (I couldn’t feel anything thanks to the anesthesia). 

Let me be honest – the pain wasn’t too bad. What was difficult was the fact that needles and sharp objects are being used right by your eye. Every instinct tells you to protect your eyes and bat away whatever is coming at you. Let me stress that the pain was almost nothing. If you can focus on remaining calm, the procedure is not a big deal. Psychologically, having a stranger so close to your eye is tough, but the physical part of the procedure is bearable.

The doctor place a shield over my eyeball to protect it during the biopsy procedure. It looks like the lens from a pair of glasses. It was a bit uncomfortable to have the shield in, but it gave me a great sense of psychological comfort knowing that my eyeball was protected. 

Once the biopsy was completed, I had very little bleeding and within two hours the swelling of my lower lid was gone. I never had any bruising. I was told by the doctor that bruising and swelling was possible for a couple of days after the biopsy. I guess I was lucky. By that evening, I just had a small red spot where the biopsy had been taken, it just looked like I’d scratched my eyelid. 

It took a week for the results of the biopsy to come back. Unfortunately, mine were positive for basal cell carcinoma.

Basal cell carcinoma on the lower eyelid must be removed. The good news is that basal cell cancer does not metastasize and spread, but it will continue to grow bigger and bigger, so it’s important to have it removed earlier rather than later. This is especially important on your eyelid because the less skin that has to be removed with the basal cell, the easier the reconstructive surgery will be.

Important tip. Don’t google photos. I did and wish that I hadn’t. You’ll find photos of situations much worse than yours and you’ll just add to your anxiety. Just. Don’t. Do. It. 

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Basal Cell Carcinoma on the Lower Eyelid – Surgery and Recovery

Eyelid Surgery 

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 waited 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 simply 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. 

Recovery

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 was 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 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 eyelashes 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. Read more about another blogger’s experience with basal cell carcinoma on the eyelid.