A corneal transplant, or keratoplasty, replaces diseased or damaged corneal tissue with healthy donor tissue to restore vision. The success of this procedure hinges on careful post-operative care, which involves strict adherence to a regimen of medications and activity restrictions. Avoiding specific actions is paramount to protecting the new graft, preventing complications like infection or rejection, and ensuring the surgical wound heals securely.
Prohibitions on Physical Strain and Pressure
Activities that cause a rapid increase in intraocular pressure (IOP) must be avoided, especially in the initial weeks of recovery. The delicate surgical wound, often held together by fine sutures, can be compromised by excessive strain, potentially leading to wound separation or dehiscence. Patients must not engage in heavy lifting, with most surgeons recommending a limit of 5 to 10 pounds for several weeks after surgery.
Any movement that forces the head below the waist, such as vigorous bending or stooping, also elevates IOP and should be avoided. When retrieving items from the floor, it is safer to squat, keeping the head upright and level with the chest. Even minor internal straining, such as coughing, sneezing, or straining during a bowel movement, can be a risk, so doctors often suggest preventative measures like stool softeners.
Mechanical trauma, even minor contact, can damage the healing graft, so patients must never rub or press on the operated eye. To prevent inadvertent injury or pressure while sleeping, wearing a protective eye shield is required, often for several weeks, or even three months, particularly at night. Any activity that risks a direct blow to the eye should be avoided for the rest of a patient’s life following a full-thickness transplant.
Strict Limitations on Water and Contamination
Infection represents a serious threat to the healing cornea, making contact with contaminated water sources and environmental pollutants strictly prohibited. Swimming in pools, hot tubs, lakes, or the ocean must be avoided for four to eight weeks due to the high risk of introducing bacteria or amoebas into the vulnerable eye. Even chlorinated pool water is a risk, as the chemicals can irritate the eye and compromise the fragile healing surface.
When showering or washing hair, patients must take precautions to prevent water, soap, or shampoo from entering the eye. A common method is to tilt the head back and wash the hair carefully, or to wear the protective eye shield during the first month. Environments containing airborne particles, such as dusty construction sites, gardening areas, or chemical fumes, must also be avoided to prevent foreign bodies and irritants from lodging in the eye.
The use of cosmetics around the eye area is restricted, primarily due to the risk of contamination and debris falling into the eye. Eye makeup, including mascara, eyeliner, and eyeshadow, should not be used for about four weeks after the procedure, which helps eliminate a source of potential infection and ensures the eye remains clean.
Restrictions on Driving and High-Risk Recreation
The ability to drive is restricted immediately following a corneal transplant until the surgeon provides explicit clearance. This prohibition is due to the fluctuating and often blurred vision experienced in the initial recovery period, which may not meet legal visual acuity standards. Additionally, the eye may be dilated or highly sensitive to light, further impairing the ability to safely operate a vehicle.
High-impact sports, such as basketball, soccer, boxing, or martial arts, are prohibited because they carry a high risk of direct trauma to the eye. A direct blow can cause the surgical wound to open (wound dehiscence), which is dangerous and can lead to severe infection and vision loss. Even non-contact activities like racket sports should be avoided for several weeks; when permitted to resume, protective polycarbonate sports glasses are strongly advised.
Returning to any physical activity must be a gradual process, and the timeline is highly individualized, depending on the type of transplant and the rate of healing. Even after the initial recovery, patients with a full-thickness transplant are often advised to protect their eye from contact activities for the rest of their lives due to the permanent weakness at the wound edge.
Non-Compliance That Threatens the Graft
One of the most significant threats to the long-term survival of the new cornea is non-adherence to the prescribed medical regimen. Patients must not discontinue or alter the dosage of their eye drops, especially the steroid and immunosuppressant medications, without consulting the ophthalmologist. These drops are the primary defense against the body’s immune system recognizing the donor tissue as foreign and mounting a rejection response.
Skipping follow-up appointments is another form of non-compliance that jeopardizes the graft. Regular examinations allow the surgeon to monitor the healing process, check for signs of infection or rejection, and adjust the medication schedule as needed, which is particularly important in the first year. The success of the transplant relies on this close, periodic monitoring.
Patients must not ignore certain warning signs that indicate a problem with the graft, as delaying reporting these symptoms can lead to irreversible damage. These symptoms are often summarized by the acronym P.R.E.D.V., which stands for Pain, Redness, light Sensitivity (photophobia), and decreased Vision. If any of these signs appear, immediate contact with the eye surgeon is necessary, as early treatment offers the best chance of saving the graft.