Is Bleeding 6 Days After Eyelid Surgery Normal?

Question

My eyelids started bleeding 6 days after my eyelid surgery. It would happen while I was asleep as well as randomly in the car. It's a watery red color and the only way I can stop the flow is with ice. My doctor wants me to wait another 2 weeks. Meanwhile, most bruising is gone and my eyes are somewhat swollen. They feel like I just got through crying for 30 minutes. Can I afford to wait 2 weeks to get help for this? How do I know this isn't bleeding behind the eye? I'm sure that as soon as I lay now, it will start to flow again.

Kenneth D. Steinsapir, MD · Answer

Dear Lowerbleph
Your description of this process leaves a lot of questions.  It is not clear if your eyelid incision was performed inside the eyelid or outside.  However the most common situation were persistent bleeding is seen is lower eyelid surgery where the incision is made behind the eyelid.  
The most common cause for this type of bleeding is a small injured blood vessel at the edge of the wound behind the eyelid.  Movement and moisture as well as blood flow in the vessel are often just enough to keep a small trickle of blood going.  It does not take much blood to be alarming.  Remember, it is not normal to be bleeding.
Normally after eyelid surgery there can be a little blood in the tears. However, a persistent situation like this warrants investigation. Typically what is done is to examine the would. Oculoplastic surgeons have a microscope in the office that facilitates this examination. Often the source of bleeding can be identified as a small injured blood vessel at the edge of the wound.  
The treatment is to numb the area and cauterize the blood vessel.  This typically ends the episode.  Having you wait two weeks may permit the vessel to eventually close off but it certainly is not a practice builder.  
I suggest that you call your surgeon's office and advise them that you do not want to wait two weeks and you would very like him to examine the wound, determine where the bleeding is coming from, and cauterize the problem.

Jonathan Hoenig, MD · Answer

Although it is normal to have bloody tears for a day or two after surgery, bleeding from the eyelid 6 days after surgery is not normal. If you are taking Vitamin E, aspirin, advil, fish oil, or other blood thinners, this could be part of the problem. You should not wait 2 weeks to address this issue. As you mentioned, bleeding behind the eye could be a serious problem and is considered a medical emergency.
It's possible that when you sleep, the sheets or pillow is pulling on the incision and opening it slightly which would account for the bleeding. If it is simply bleeding from the inicision, this is not an emergency but continually reopening the wound will cause a larger scar to form.
If your doctor is unwilling to look into this further now, I suggest you get a second opinion from an oculoplastic surgery who is uniquely qualififed to address your concerns as both an opthalmologist and a plastic surgeon. You can find one at www.asoprs.org.

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