Postoperative systemic antibiotic usage in elective eyelid surgery: is it really necessary?

The use of prophylactic antibiotics for oculoplastic procedures varies because of a lack of specific guidelines or literature. Comparable studies in clean orbital surgery have shown no proven benefit and its indiscriminate use has been linked to individual harm and rising levels of resistance. We investigated whether avoidance of systemic prophylactic antibiotics in elective lid surgeries increased surgical site infections (SSI).

We conducted a case-note audit of consecutive anterior ptosis repair and lateral tarsal strip (LTS) surgeries performed with post-operative oral antibiotics (co-amoxiclav or clarithromycin) and topical chloramphenicol ointment, compared to only topical antibiotics. Data on American Society of Anesthesiologists (ASA) status, age and incidence of surgical site infection at 2 weeks follow-up were collected.

Of a cohort of 232 patients, 99 patients had combined systemic and topical antibiotics (ptosis n = 49, LTS n = 50) and 133 had topical antibiotics (ptosis n = 83, LTS n = 50). The groups were not significantly different for age (p = .6, t-test) or ASA status (p = .7, chi2 test). Three patients from the combined group required further treatment for SSI compared with two patients from the topical antibiotic group (p = .7 Fisher's exact test).

Avoidance of systemic antibiotic prophylaxis for LTS and anterior ptosis repair procedures was not associated with increased SSI rates. Given that prescriptions of antibiotics carry the risk of side-effects and growing antimicrobial resistance, we feel that our study shows that its routine use in this setting is of no benefit.