DEAR DR. ROACH: I am a 75-year-old woman who had successful cataract surgery two months ago. However, it left me with swollen eyelids and noticeable pouches under both eyes. My doctor advised that some people have a reaction like mine. I was told that the swelling should abate by six months. The healing was excellent, and I see fine, with the exception of the drooping eyelids. The seniors I know who had cataracts out and lenses in did not have a reaction like mine.
What would cause this to happen? Could I be allergic to the lenses that were inserted? Is this a common occurrence? -- Anon.
ANSWER: Drooping eyelids, called ptosis, is fairly common after cataract surgery, happening about 10 percent of the time. Most of the time, it goes away by itself, and the six-month time period your doctor told you is supported by what I found in the published literature. There are many causes, and people who get eyelid swelling are more likely to get the drooping of the eyelids. If it persists, surgery may be required to fix it. However, this is unlikely. People should know this is a possibility before undergoing cataract surgery.
DEAR DR. ROACH: You were recently asked about Pap tests for the elderly, and gave the same answer that troubled me a year or so ago. I meant to write then.
I fear that others may discontinue pelvic exams after age 80, as my mother did, with fatal results. She was 84 and had done all the right things: proper diet, exercise, dancing, walking on the beach, going out to shows, reading, socializing, volunteering, etc. For years she’d gone to a doctor who had taken good care of my father. But it wasn’t until a friend took her to his (younger) doctor because she was in such pain and insisted she be seen that she was diagnosed -- too late, of course.
I’d be grateful if you’d mention in your column the added warning to continue pelvic exams for the elderly. -- J.B.
ANSWER: I do agree that women should continue to get regular exams and checkups, including gynecologic exams, even if they no longer need Pap smears. However, I don’t want to paint too optimistic a picture for the physical exam as a screening test for ovarian cancer. While they are better than nothing, there is no effective test, including imaging (such as an ultrasound), blood test (such as CA-125) or physical exam. No screening is recommended or has been shown to cause more good than harm in women who have average risk for ovarian cancer. I dearly wish this weren’t the case, since ovarian cancer is the leading cause of gynecologic cancer deaths. I have been following the literature on new blood tests that might become useful in screening for ovarian cancer, but so far none is generally available.
Women at high risk for ovarian cancer, such as those with a genetic BRCA mutation, should be evaluated for screening by an expert. Women also should be aware of the symptoms of ovarian cancer, which include abdominal bloating or swelling, lower-abdominal or pelvic pain, poor appetite and weight loss (or gain, especially with abdominal swelling). Unfortunately, these symptoms are not specific, and even if women come in immediately upon recognizing then, it often can be too late, which is why an effective screening test is so urgently needed.
Many letters ask about cervical cancer and Pap smears. The booklet on those two topics explains both. Readers can order a copy by writing: Dr. Roach Book No. 1102, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.