Dry Eye - Temporary or Permanent After Upper Bleph?

In some cases I hear dry eye is 'permanent' after eyelid surgery (or ptosis repair for that matter). If it is permanent, does it usually mean that too much skin was removed, tearing mechanism (lacrimal gland) problems, decreased blink (muscle removal), etc etc. This is my most considered risk (and am thorough in researching it), but I know that most cases are temporary (swelling or such). But when is it permanent, and what causes it?

Doctor Answers (23)

Dry Eye - Temporary or Permanent After Upper Bleph?

+4

There are potentially several mechanisms on how one could develop dry eye after blepharoplasty or ptosis repair.  Some are temporary and some are permanent.  With this in mind, you need to get a full Oculoplastic examination to make sure that you are not predisposed to permanent dry eye after eyelid surgery.  once that is determined then most dry eye complaints are temporary.


Beverly Hills Oculoplastic Surgeon
4.5 out of 5 stars 13 reviews

A Qualified Surgeon Can Protect You From Dry Eyes

+4

The most important step in preventing postoperative complications with dry eyes after surgery is not the surgery itself or how much skin is removed.  

Three steps to avoiding dry eyes after eyelid surgery:

  1.  The most important step is  a good medical history Medical History.  The surgeon should find out         whether you have any history of dry eyes or have been treated for conditions related to dry eyes.  Do you frequently use moisturizing eye drops.  Have you had Lasik surgery which can decrease the sensitivity of the eyes and place you at risk.  Have you ever been treated with punctual plugs or Re-stasis for dry eye conditions.  Thyroid disease, Sjogren's syndrome can also contribute.  And the most important of all.  Have you had previous eyelid surgery.
  2. If your eyes are dry for any of the above reasons it is important that you have a thorough ophthalmologic exam including a slit lamp exam and schirmer tear test prior to any eyelid surgery.  These are important tests to help determine if your eyes are too dry for eyelid surgery.
  3. If your are a reasonable candidate based on the History and Physical exam above then seeking out a skilled surgeon who will not remove too much skin and using eye drops (Refresh Plus) for a few weeks after surgery will protect you from dry eye complications.

Follow the above steps and you will not have to worry about the possibility of long term dry eyes

David L. Mobley, MD, FACS
Sarasota Plastic Surgeon
5.0 out of 5 stars 11 reviews

Dry eyes after upper blepharoplasty

+3

There is approximately a 3% occurrence of dry eye after an upper blepharoplasty procedure. The current thought on the mechanism of this dryness is from removal of the orbicularis oculi muscle on the upper lid. It does not involve the lacrimal glands or tearing mechanism. If your eyes are currently dry, they can become drier which is more noticeable after an upper blepharoplasty. We do not perform an orbicularis oculi muscle strip in dry-eyed patients as a general rule.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 56 reviews

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Dry eye after blepharoplasty or ptosis surgery

+3

Dry eye after blepharoplasty or ptosis surgery is usually temporary.  Tears are made up of three components, water, oil and mucous.  The oil and mucous components of the tears originate mostly from the smaller glands which are located in the lid margin.  Swelling will cause these glands to function poorly in the immediate post-operative period resulting is dry eye symptoms.  Tearing is a paradoxical effect.  The brain will sense that the eye is dry and cause the lacrimal gland to secrete more tears.  Problem is that these tears are more water in content and therefore do not have the same quality as normal tears and are less effective at lubricating the eye. 

Dry eye that is permanent is usually a result of too much skin being taken in the case of blepharoplasty or the muscle being shortened too much in the case of ptosis.  Excesses however are relative and what is too much in one patient may be just right in another.  Pre-existing dry eye patients may be at a much higher risk of this and need to have more conservative surgery to protect the eye.  Lasix may also pre-dispose to dry eye and blepharoplasty should not be undertaken within 6 months or so of this procedure. 

Usually selecting a surgeon who will pay attention to the patients pre-operative eye condition and perform a procedure that is conservative enough for that patient will prevent permanent dry eye from occurring. 

Edward Buckingham, MD
Austin Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Is dry eye temporary or permanenet after blepharoplasty?

+3

Dry eye can happen after upper Blepharoplasty but it usually resolves after the initial healing. There are however people who have dry eye condition before an upper Blepharoplasty is done and if such condition exists then an upper Blepharoplasty should not be done. The dry eye syndrome, if not treated, can cause the cornea to scar and cause blindness.

So this is a matter of finding out if the patient suffers from dry eye before the surgery. A Schirmer test can be done in the office to check for the tear production and to rule out dry eye.

Farhad Rafizadeh, MD
Morristown Plastic Surgeon
5.0 out of 5 stars 19 reviews

Dry Eye after Blepharoplasty

+3

Some degree of dryness after an upper blepharoplasty is normal and should be expected. This can easily be treated with moisturizing drops in the post op period. When this dryness or irritation persists for months, it is a greater concern and should be evaluated by the surgeon and possibly an ophthalmologist. Too much skin removal is possible but extremely rare, as is lacrimal gland damage. If you already have dry eye then you should think carefully before proceeding to surgery, and be "cleared" by an ophtho doc.

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 19 reviews

Dry eyes after blepharoplasty

+3

Hello potential blepharoplasty patient from Los Angeles.  First of all, prior to any eyelid surgery you should be thoroughly evaluated for any preexisting dry eye conditions.  This may require an evaluation by an ophthalmologist with something called a Schirmer test which will evaluate your tear producing ability.  If you do not have any preexisting cause for dry eye syndrome, then you are less likely to have an issue post-operatively.  During your early post-op period is would be wise to use a lubricating eye drop for any signs of dryness, which are usually due to increased eye exposure from the necessary skin excision.  It is not uncommon for this to happen temporarily as your eyes adjust to their altered anatomy.  The eyelids may be tight and leave a small gap when you try to close, known as a lid lag.  this will usually improve with time and healing as the lid readjusts to its new position.  As long as you choose a surgeon who is familiar with upper blepharoplasty and has adequate training and experience, you should not be left with a permanent lid lag, which would result from too much of a skin excision.  Good luck to you, and I hope this helps.

Mark Ginsburg, DO
Media Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Dry Eye - Temporary or Permanent After Upper Bleph?

+2

Very rare to have this complication following ONLY an upper lid blepharoplasty. Drs Wallach & Schimmer are correct in the preoperative evaluations for dry eye syndrome tendencies and treatments after. Regards from MIAMI Dr. Darryl j. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Dry Eye after Upper Blepharoplasty

+2

Dry eye is very common after upper and lower Blepharoplasty and somewhat frequent after only upper. It is almost always temporary. When permanent, there is usually some underlying reason that can usually be found and treated before the surgery. Discuss your fears and any present symptoms with your surgeon before surgery.
 

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 4 reviews

Dry eye after eyelid surgery is usually temporary

+2

Although dry eye after eyelid surgery is common, it is usually temporary.

In early stages of healing the eyes are swollen and stiff and the blink reflex is diminished. Frequent use of non-preserved artificial tears is usually sufficient to give patients relief. Sometimes a mild steroid drop or lubricating ointment is needed for more sever cases.

In my experience as an Oculoplastic Surgeon, most cases of permanent dry eye are related to lower eyelid function. If the lower eyelid is retracted, then the tear film can not adequately lubricate the eye. Retraction of the lower eyelid usually resolves over time. In some cases reconstructive surgery is needed.

David Schlessinger, MD
Long Island Oculoplastic Surgeon
4.5 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.