Getting ready for eyelid or orbital surgery: what to arrange beforehand

It is easy to spend weeks deciding whether to have eyelid or orbital surgery and far less time preparing for it. The preparation deserves its share. The decision has its own pieces: what a second opinion is actually for comes first. What follows the operation is covered in the week by week account of recovery after upper eyelid surgery and in the wider recovery timeline. This piece sits between the two: what to tell your surgeon, and what to arrange, before the day.

Everything below is general. Your surgeon's own instructions, given for your operation and your health, always come first, and where this piece and those instructions differ, follow the instructions.

Which medicines and supplements should I tell my surgeon about before eyelid surgery?

All of them, including the ones you do not think of as medicines. That means anything prescribed, anything bought without a prescription, and every vitamin, herbal product and supplement. The reason is bleeding. Eyelid skin is thin and sits over a rich network of small blood vessels, so anything that changes how easily you bleed or bruise matters to the person operating there.

The NHS puts it plainly: the surgeon needs to know if you take medicines to reduce your risk of blood clots. Moorfields Eye Hospital's private service asks for the same disclosure at the first consultation, and Cambridge University Hospitals asks patients to bring a list of all their medicines, or a current repeat prescription from the family doctor. Supplements deserve a line of their own. A 2022 review in Ophthalmic Plastic and Reconstructive Surgery notes that many supplements have an antithrombotic effect, meaning they can slow clotting, and lists garlic, ginkgo, ginger, ginseng, fish oil, vitamin E and selenium among them. Bring the bottles or a photograph of the labels rather than relying on memory.

Should I stop my blood thinner before eyelid surgery?

No, not on your own. A medicine that was prescribed to you is stopped, continued or adjusted by the doctor who prescribed it, in agreement with your surgeon. Anticoagulants, which slow the blood's clotting, and antiplatelets, which stop platelets clumping together, are usually prescribed to prevent a clot in the heart, the brain or a leg. Stopping them trades one risk for another.

The same 2022 review, by Kim and colleagues, says the decision on perioperative management of these medicines should be made in conjunction with the patient's internist, cardiologist, haematologist or other involved physicians, and that guidance should be applied case by case. It also reports that patients who stop one long-established type of anticoagulant, for any reason, face roughly a 1% risk of a clot-related event within 30 days. That figure is not a reason to be frightened. It is a reason the conversation happens between doctors.

Practice is also moving. A 2026 retrospective study of 392 patients having upper blepharoplasty, 100 of them on anticoagulant or antiplatelet therapy, found no major bleeding events and no significant difference in overall complications. Its authors are careful to note the limits: a single centre, a retrospective design and low statistical power, and they call for larger prospective studies. So surgeons and units differ in how they handle this, which is one more reason to say exactly what you take and let the doctors agree a plan. If you have already been told to stop or to carry on, bring that in writing.

Do smoking, contact lenses and eye make-up matter before eyelid surgery?

Smoking matters most, and I would rather you told your surgeon than tidied the answer. Leeds Teaching Hospitals states that smokers are known to have healing problems and asks patients to say if they smoke or have stopped. Moorfields adds that a surgeon may recommend stopping for a few weeks before surgery, because smoking can slow recovery. Whether that applies to you is a decision for your own surgeon, and being honest about it changes nothing except how well you are looked after.

Contact lenses matter after the operation more than before it. Moorfields advises avoiding them during recovery, and in the recovery timeline the usual wait is at least two weeks. Practically, that means having a pair of glasses you can see well in, with a current prescription, ready before the day. Ask the clinic when you should stop wearing lenses beforehand and what it wants on the day: clean skin, no eye make-up, no lotions. Those instructions vary between clinics, so take them from the team who is operating rather than from any article, mine included.

What will the surgeon assess and photograph before eyelid or orbital surgery?

The surgeon assesses where the lids sit, how strongly the lifting muscle works, how well the eyes stay moist, and takes photographs to plan the operation and compare afterwards. All of it changes what is done, because the assessment decides the operation, not the other way round.

EyeWiki, the American Academy of Ophthalmology's clinical wiki, describes the standard measurements for a drooping lid. One is the distance from the centre of the light reflex on the pupil to the edge of the upper lid. The other is levator function, how far the lid travels from looking down to looking up while the brow is held still. The levator is the muscle that lifts the upper lid. The same page stresses that loose skin and a low brow have to be told apart from ptosis, the medical name for a droopy lid, because the surgery differs, which I set out in what ptosis surgery involves. It also says external photographs are good to obtain before surgical correction.

Dry eye is the part patients least expect to be asked about. EyeWiki calls it very important to examine for dry eye, with a dye to stain the cornea, the tear meniscus and the tear break-up time, to judge whether surgery is safe. Moorfields notes that patients with dry eyes will have less tissue removed to avoid increased exposure. So tell the surgeon if your eyes are gritty, burning or watery, and if you already use drops. What follows when dryness is present is covered in dry eye after eyelid surgery. Moorfields also says you may be asked to bring older photographs, which help plan surgery to suit your own features.

What should I arrange at home: a lift, help, cold compresses and time off work?

Arrange a lift home, an adult to stay with you, a supply of cold packs and a realistic block of time off. Moorfields says to make sure someone is available to take you home and watch over you for several hours after surgery, and the NHS notes you will not be able to drive for a number of days. Book the lift before the day, not on it.

Help matters beyond the first evening. Sort out meals, whoever will do the school run and who will remind you about drops or ointment, because swollen lids make small tasks slower. Cold packs are standard in the first day: one NHS trust leaflet describes ice packs for the first 24 hours, and the week by week recovery piece explains why. Put clean packs in the freezer beforehand, with a soft cloth to wrap them, and set up extra pillows so your head can rest raised.

The NHS says most people take about 2 weeks off work, depending on the job. That is a typical range, not a promise, and the recovery timeline explains why a desk job and a physical job differ. If your job involves bending or lifting, tell your employer early and plan for a longer wait than you would like.

What should I ask at the pre-operative visit?

Ask what the operation is, what it is for, what could go wrong in your case, and who to call afterwards. A good visit ends with you able to repeat the plan in your own words. These are the questions I would bring:

• What exactly is the operation, and is it treated as medical or cosmetic? That distinction changes what a quotation includes.
• Which anaesthetic is planned, and will I go home the same day?
• Which of my medicines and supplements matter, and will you speak to the doctor who prescribes them?
• What are the risks in my case, including dry eye, and how would you handle them?
• What should I do on the day before and the morning of surgery, including eating, drinking, lenses and make-up?
• Who do I call, and when, if something feels wrong, and when is the first follow-up?

If the answers leave you unsure of the diagnosis or the plan, that is what a second opinion is for, and how to choose an eyelid surgeon in Malaysia covers what a consultation should include. The wider questions worth settling sit together in before you decide, and if you are still asking whether surgery is needed at all, start with what actually makes eyes look tired.