ICL is a very cool procedure. But ICL surgery is still a surgery and still requires some minimal effort on your part afterwards to make sure that everything heals up exactly the way it should.
What exactly are we trying to prevent after the surgery?
- Infection!
That's really the main thing. And while it's incredibly rare with ICL, it doesn't mean we can ignore it all-together. Thus, there are certain restrictions after ICL to prevent an infection as much as possible. Let's explore the basis for why these certain precautions exist.
Rewind to the procedure itself
ICL surgery is actually a very quick surgery with a very quick recovery (see also What Is ICL Surgery?). A large part as to why the surgery and the recovery are so quick is that the tiny incisions made during the procedure are all self-sealing. Zero stitches are needed after ICL surgery. This makes the surgery go quicker (since it takes some extra time to place a stitch). This makes the recovery very quick as well.
Having a stitch placed means that it will eventually need to be removed. This would typically be done at the 1 month post-operative visit. In the meantime, the stitch can affect the vision ever so slightly by created some temporary astigmatism. The stitch can delay the recovery of vision. In addition, while in most cases you can't feel the stitch, occasionally you can slightly perceive the stitch in the eye.
So there are lots of benefits to having a self-sealing incision. At the end of the procedure, the surgeon simply confirms that there are no leaks present - the incision has fully sealed up.
On to the first week
Now that we have an ICL in place with no leaks, we want to keep it that way. If a leak develops, fluid can obviously leak out, but more of an issue is that there is a possibility that fluid outside the eye can flow INTO the eye. If there is bacteria sitting on the eye, this provides a potential route for bacteria to enter the eye.
Sounds problematic, but there are actually some natural defenses which help prevent this and why the infection risk is incredibly low with ICL.
- The first involves the very front "skin-like" layer of your cornea called the epithelium. The epithelium is our natural barrier on the cornea protecting us from bacteria. The incision during ICL surgery creates a scratch through this epithelium, but pretty quickly after surgery, the epithelium heals over this scratch. Thus, it restores the natural barrier to prevent things from entering or leaving the incision.
- In the event that some bacteria make it through the epithelium barrier and incision and into the front part of the eye, the second natural defense kicks in. The fluid in the front part of the eye, called aqueous humor, is constantly being produced and drained out of the eye. About every 1.5 hours, there is a complete turnover of this fluid. This means that if the bacteria makes it into the aqueous humor, there is a very high chance that it will be washed out before it gets a chance to take hold and cause an infection. Infections within the eye typically occur if the bacteria is able to make it's way into the jelly-like substance (called the vitreous) in the back of the eye. Your large natural lens within your eye is a large wall blocking access to the vitreous.
So the eye has natural defenses, but this is surgery, we don't want to have to rely only on natural defenses. We want to be proactive. How do we do this? In two ways: prevent anything that can cause the ICL incision to leak and prevent any bacteria from getting onto the surface of the eye.
Keeping the ICL incision sealed up
What can cause the ICL wound to leak? Well, rubbing and pressing on the eye can do it. Pressing on the eye raises the pressure of the eye. By natural laws of physics, fluid flows from high pressure to low pressure. If you raise the pressure inside the eye, the fluid is going to "want" to find lower pressure ie through the incision and outside of the eye. So during the first few weeks, we don't want to rub the eye.
But there are also other things that can increase the pressure of the eye. Bending over can cause blood to rush to the head. In this same way, it can also increase the pressure in your head. This increase in pressure can be transmitted to your eyes and increase the pressure in your eyes. You will want to avoid bending over as much as you can during the first few weeks. And especially hold off on using your inversion table!
Lastly, you will want to hold off on activities that cause you to strain. This includes heavy lifting or vigorous activity. During these activities, it's common to not exhale like you normally would. This act is called a Valsalva maneuver and it increases the pressure within the head. Again, this pressure increase can raise the pressure in your eyes. Not what we want. So during the first few weeks, don't lift heavy objects or have strenuous activity.
Preventing bacteria from getting on the eye
This one is easier. Bacteria exist..well almost everywhere. But water sources are the main concern for the eyes. Lakes, oceans, rivers, while they look clean and pure (in most cases), they will contain bacteria. After ICL surgery, it's important to avoid swimming for the first few weeks for sure. And in general, you really don't want to be getting tap water in your eye. It's ok to shower, but close your eyes when rinsing and washing your hair. The eyelids will provide a great barrier to keep water out of the eye.
The long term
The restrictions are really only needed for the first few weeks. Eventually the ICL incision will develop a small amount of scarring. This scarring acts like velcro to secure the ICL incision shut. After a few weeks, it becomes difficult for that ICL incision to leak unless you are intentionally trying to make it happen.
So what are the long term precautions? Really nothing. In general, I would still recommend avoid getting hit in the eye but that would apply even if you didn't have ICL surgery. After a few weeks of avoiding swimming, strenuous activity, bending over and rubbing your eye, you're good to go! You can enjoy your brand new vision worry free!
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