Postoperative Elevation of Eyeglasses from the Nasal Bridge
After surgery on the proximal nose, wearing eyeglasses may be difficult and uncomfortable. A bulky wound dressing may not allow eyeglasses to rest in their proper position. Even if the patient or physician can adjust the wound dressing so that eyeglasses lie in a functional position, the patient may still experience discomfort from continuous pressure on the bridge and sides of the nose. This pressure can impede vascular supply and thus may modify the wound healing process.
The skin on the nasal bridge is thinner in elderly individuals than in young individuals. Such thin skin tends to be more susceptible to pressure-induced problems and maceration. Therefore, removing pressure from eyeglasses to minimize wound healing problems may be particularly important in the elderly.
Optical devices and readily available materials can be used to decrease or eliminate pressure on the nasal bridge from eyeglasses.
Adhesive tape may be used to suspend the bridge of the eyeglass frame by looping one end of the tape around the bridge and fixing the other end to the midforehead. This technique is used often because it is simple and adhesive tape is readily available. Tape adheres more securely if the skin has been degreased with alcohol. We have found that a plastic medical tape with good adhesive properties such as Micropore(3M) works best. The drawback of using tape is that it slips with time and needs to be replaced frequently. Also, use of tape may cause contact dermatitis or skin irritation in certain individuals.
Padding can be used to distribute pressure. A surgical dressing with gauze and tape offers some padding and distribution of pressure. However, after the wound is superficially healed, such a dressing becomes unnecessary, and other types of padding may be used. Nosepiece pads (Cushion Rests) are small adhesive-backed cushions that can be attached to the nose pads on eyeglasses. These cushions do not distribute pressure over a broad area and therefore will not alleviate pressure-induced problems. In contrast, padding larger than the nose pads distributes pressure over a large area. Such padding (eg, Dr. Scholl’s Callous Pads or Duoderm Surgical Dressing) can be cut to size and placed directly on the skin extending across the bridge and sides of the nose underneath the nose pads. Two main drawbacks of padding are: 1) it reduces but does not eliminate pressure; and 2) it may not be sterile and therefore would not be suitable for use on healing wounds. Both Dr. Scholl’s Callous Pads and Duoderm Surgical Dressing have adhesive on one side and are easily fixed to the skin.
For a proximal nose wound that has been allowed to granulate or that is sutured primarily, a sterile dressing such as Duoderm, which provides cushioning of eyeglass pressure, may be particularly useful. Duoderm may be left in place for days without being changed. However, if the wound is open and drains continuously, the hydrocolloid material will liquefy and run. If the wound is sutured and Duoderm is applied directly, the suture tails and knots will adhere to the Duoderm. Such sticking makes suture removal difficult and may result in wound dehiscence.
After rhinoplasty, the nose is splinted for protection. Splinting is usually accomplished with either plaster of Paris or a conforming adhesive splint known as The Denver Splint. Because both of these materials are bulky, the eyeglasses sit too high on the nose and vision is impaired. Therefore, we do not recommend these rhinoplasty-splinting materials to alleviate pressure of eyeglasses.
Paired clip-on pedestals (Frameups) that attach to the bottom of each eyeglass frame are available; the pedestal bases rest upon the malar eminences and elevate the eyeglasses so that the nosepieces do not rest on the nose. Clip-on pedestals are relatively conspicuous. They cannot be attached to rimless glasses, and their efficacy depends on the slope and prominence of the patient’s malar eminences and size of the lenses and frames. In addition, glasses with clip-on pedestals tend to shift position with changes in facial expression.
The headband eyeglass suspender (Noseguard) is a simple although unattractive device. This apparatus consists of a padded, T-shaped plastic frame held in place on the forehead by an adjustable elastic band; at the base of the T is a hook in which the bridge of the eyeglass frame rests and is thus suspended above the nose. The drawbacks of this device include its conspicuousness and its compression of hair.
The bridgeless eyeglass frame is a specially designed frame made of one continuous curved plastic piece that wraps around the forehead and has two temple pieces attached. On the forehead the frame rests on the bony orbital rims. Suspended from the wrap-around frame are two lenses that may be flipped up or down. The bridgeless eyeglass frame is expensive, and the patient must be specifically refracted and fitted for optimal vision. The main use of this optical device is during long-term surgical restoration of the nasal bridge.
Discussion For the patient who must wear eyeglasses, a surgical wound on the proximal nose may represent a problem. Some modification may be necessary because of a bulky surgical dressing, pain, or pressure, so that the patient can continue to use his or her eyeglasses during wound healing. We have reviewed techniques using optical devices (some of which are difficult to obtain) and readily available materials that we have found useful under certain circumstances to circumvent the problems produced by eyeglasses during the postoperative period.