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Joy Efron
Joy R. Efron, Ed.D.

The recovery process from surgery for my pseudohole was difficult. I experienced three complications following vitrectomy surgery for my pseudohole:

  • Frozen shoulders as a result of face-down positioning
  • Side effects from my eye drops, including elevated eye pressure, fatigue and exhaustion, and dry eyes
  • Development of a cataract

Shoulder Contraction and Shoulder, Neck, and Lower Back Pain

In 2009, the six-week face-down procedure following macular hole surgery was miserably uncomfortable, but as soon as it was over, I was fine.

In 2012, following pseudohole surgery and face-down positioning for only ten days, the pain in my neck, shoulders and lower back continued to worsen. Unfortunately, my shoulders had become severely contracted and rigid in the face-down position and I needed intensive physical therapy and massage therapy for four months.

My muscles were so rigid that during multiple therapy sessions, the description of my shoulders by doctors, physical therapists, and massage therapists was “Iron!” “Steel!” “Rock!” “Bone!” One professional told me that on a scale of 1 to 10, with 10 requiring hospitalization, I was a 9+. No one seemed to know why my shoulders contracted so severely and froze. It is important to note that while it required extensive therapy for four months, the situation totally returned to normal.

If you will need to be face-down, please be sure to order equipment and prepare in advance. Since my surgeon was not certain if I would have to be face-down for the pseudohole surgery, I did not order the face-down kneeling chair initially. When it arrived on day five, my shoulders were already very contracted.

See Suggestions for Maintaining Face-Down Positioning After Macular Hole Surgery and Suggested Resources for More Information on Macular Hole Surgery for more information about equipment, resources, and positioning suggestions.

In addition, I recommend the following:

  • If possible, have daily massages. If the cost is prohibitive, ask visitors to massage your neck, shoulders, and back.
  • Consult with a physical therapist for stretching exercises that you can do for your arms and shoulders while in the face-down position.
  • Generously use towels and pillows under your armpits to support your arms and shoulders.

However, if you are confronted with a difficult post face-down recovery, due to tight muscles, the following may be helpful to you, as they were to me:

  • Massage
  • Physical therapy
  • Stretching exercises
  • Muscle relaxers (prescription)
  • Shoulder injections (prescription)
  • Hot baths
  • Jacuzzi
  • Rest
  • A corn-filled fabric bag that you can heat in the microwave and place on your neck
  • ThermaCare Therapy Heatwrap (a non-prescription product)
  • Heating pads
  • Cold packs
  • Tylenol
  • Eucasol, Biofreeze, Mobisyl, Arnica and other topical muscle creams and oils.
  • You can learn more about these suggestions and products at Suggested Resources for More Information on Macular Hole Surgery

Reaction to Eye Drops

Following eye surgery, eye drops are a necessity. I had some extremely negative reactions. All medication can have side effects. I am usually very sensitive to medication and don’t like to take anything unless absolutely necessary.

Eye surgery causes inflammation. Inflammation and edema (the accumulation of fluid) can cause serious damage to the eye. Steroid eye drops are necessary to control inflammation. About 15% of people react to steroid eye drops with increased intraocular [i.e., within the eye] pressure, or IOP. High IOP can damage the optic and nerve and cause glaucoma, a group of eye diseases that can lead to blindness.

Elevated Eye Pressure

After my first vitrectomy surgery for a macular hole in 2009, I reacted to the prescribed prednisolone steroid eye drops with a tremendously elevated pressure IOP of 42. It took three different medications and two months for my IOP to return to normal. Fortunately, no harm was done to the optic disk and nerve and my IOP has remained within normal limits. When I had subsequent cataract surgery, the doctor used a different steroid, to which I had no reaction.

[Editor’s note: Most eye care professionals define the range of normal intraocular pressure (IOP) as between 10 and 21 mm Hg, or millimeters of mercury, which is a pressure measurement. Most persons with glaucoma have an IOP measurement of greater than 21 mm Hg.]

After my second vitrectomy surgery for a pseudohole in 2012, prednisolone drops were prescribed again and I reacted the same way, with very high IOP. As a result, two glaucoma medications were added to my eye drop regimen, one of which, the generic levobunolol, was a beta-blocker. You can learn more about the different types of glaucoma medications at What Are the Different Treatments for Glaucoma?

Fatigue and Exhaustion

A few days later, I started feeling fatigued and exhausted and this kept increasing, accompanied by headaches. Then I started getting dizzy and needed my husband’s arm to walk safely. Then the fatigue and headaches began to prevent me from sleeping. Every day was a little worse.

Was I sick? Was it possible my body could be reacting to eye drops? Research confirmed the latter. The beta blocker glaucoma medication has the possible systemic side effects of low blood pressure, exhaustion, fatigue and headaches. I called the doctor and he changed my medication immediately. By the next day, my headaches were gone and my energy started to return. My systemic reaction to the beta blocker eye drops was unusual and extreme.

See Complying with Your Eye Medication Regimen and Tips for Taking Glaucoma (and Other) Eye Drops for helpful techniques and adaptations that can help you take your eye drops more effectively and comply with your eye drop regimen.

Keeping Track of My Eye Drop Regimens

I found it essential to make a chart, set a timer or alarm, and mark the chart every time I inserted eye drops. If you are not going to be home, put the eye drops in a plastic bag with some waterless soap, tissues, your chart, and a pen. Of course, wash your hands carefully before every application.

See Using Large Print, Lighting for Reading, and Signing Your Name and Handwriting for more information about making and eye chart and recording your dosage information.

Over an eight-week period following surgery, I used approximately 350 applications of eye drops (five different medications). They were used for varying numbers of days, as well as varying numbers of times per day and various numbers of drops per application. Additionally, each eye drop medication has its own schedule of tapering off. Every few days the combined dosage is different. Sometimes the doctor would change the particular medication. I don’t care how organized a person may think she or he is – an eye drop chart is absolutely necessary.

Dry Eyes

Dry eyes often occur as we age. However, I had never had such a problem until after my surgery. One of my eye doctors told me that all the chemicals from the necessary eye drops sometime cause pitting of the surface of the eye and that contributes to dryness. The doctor has said that I do produce tears, but perhaps not in sufficient quantity or strength.

Now I use eye drops whenever my dry eyes are bothering me. I’ve also found that using a vaporizer, humidifier, or simply putting a large pan with water by the bed puts sufficient moisture in the air and helps prevent my waking up at night with that dry burning sensation. In a hotel, you can simply fill a wastebasket with water.

If you have dry eyes, check with your ophthalmologist in order to rule out any other cause and to ask what you should take for relief of the discomfort. You can learn more about dry eye causes and treatments at What Is Dry Eye?.

Development of a Cataract

After a vitrectomy, a cataract will usually start to form and, over time, increase in density. However, the doctor will want to make sure the eye is totally healed from the vitrectomy surgery before performing cataract surgery.

I recommend selecting a cataract surgeon who has had experience doing cataract surgery on patients who have also had vitrectomies. One ophthalmologist explained to me that cataract surgery on vitrectomy patients is tantamount to “working in a sloppy environment without supportive structures.”

The day after my first cataract surgery in 2009, seven months after my vitrectomy surgery for a macular hole, I returned to the doctor, my eye patch was removed, and I was absolutely ecstatic! Colors were bright; distortion was almost totally gone; visual acuity was about 20/30. My visual acuity continued to improve for almost a year.

Following my second vitrectomy in 2012 for a pseudohole, cataract surgery was delayed until nine months after the vitrectomy. The doctor warned me not to expect the same kind of result as in the first eye, because this second cataract was very dense and the pseudohole had probably precluded as good a result as last time. He also warned me to expect slower healing. My cataract surgery lasted 2-3 times longer than conventional cataract surgery, due to my history, its particular challenges, and the great care taken by my surgeon.

When I returned to the surgeon the next morning, I was still anticipating the remarkable results achieved with the first eye. However, this time it was devastating. I could barely see the big E on the eye chart and everything was very blurry. Additionally, I was seeing a lot of floaters. After extensive exams and consultation with the retinal specialist, it was determined that there was a great deal of corneal swelling and my iris was somewhat “loose.” As a result, the floaters were from the iris – not from the vitreous – and not from a detached retina, which was a concern at the time.

I was told it would probably be two months until I could see well and was put on four different eye medications (four times per day for each one) plus an ointment at night. By the next day, my vision started to improve. It continued to improve hourly. It took a few days for the floaters to totally disappear. At the end of the first week, my visual acuity measured almost 20/30! I am very grateful to both of my highly skilled surgeons: the vitreo-retinal surgeon and the cataract surgeon who had experience with vitrectomy patients.

Cataract surgery is generally a safe procedure but there are risks of infection and of macular edema (swelling or accumulation of fluids in the macula). Therefore, it is critically important to take all of your eye drops, exactly as prescribed.

Additional Information on Macular Pseudohole

Also see Suggested Resources for more information about helpful products and organizations, as well as the author’s contact information.

A Disclaimer

I was an educator of blind and visually impaired children for 42 years. Although I have read and researched a great deal and have had extensive discussions with retinal specialists, I am not an ophthalmologist or medical doctor.

Reviewed by Mrinali Patel Gupta, M.D., VisionAware Medical Consultant