What is the safest way to avoid permanent dry eyes from blepharoplasty? (uppers and lowers)
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Upper and lower eyelid surgery with dry eyes
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Best surgical technique to avoid dry eyes after upper blepharoplasty
The standard technique of upper lid surgery depends on removal of lid skin for its result. This is a risk, because it is usually necessary to tighten the lid skin for it to be smooth. Whereas, when the tarsal fixation technique is used, the desired aesthetic result is obtained without depending on skin removal.
This is a point of key importance. The tarsal fixation technique first contours the ‘apparent skin excess’ into the depth of the lid crease. Only then can it be determined if there is any ‘true skin excess’, which is removed. As a result, compared to a standard lid operation, less lid skin, if any, removed. The remaining skin is stored in the lid fold and crease as a functional reserve. As the upper lid ‘lengthens’, as occurs when looking down and in lid closure, this skin reserve is automatically released so there is no interference with lid closure.
I am about to publish on a series of patients who had secondary upper lid surgery, on average 8 years after their primary. All had the tarsal fixation technique and not one of the 100 patients developed ‘dry eyes’.
Blepharoplasty and dry eye
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Any surgeon who has never seen dry eye after eyelid surgery does not know what to look for.
I am a little discouraged that you are planning to have eyelid surgery with an oculoplastic surgeon but the surgeon did not perform a schirmer's test. While the Schirmer's test is not that great a test for predicting a post operative dry eye, it is an important diagnostic test that has some predictive value and it is very easy to perform. Not performing it is like cutting a corner. If you have had your preoperative assessment with this particular surgeon and they did not perform a Schirmer's test, you should be concerned about the diligence of the surgeon in my opinion.
There are very good strategies for avoiding dry eye. First is deciding if the eyelid surgery is even needed at this time or if there are non-surgical options for accomplishing you goals. Second there are excellent surgical strategies to minimize the risk of post surgical dry eye. Dry eye after surgery has nothing to do with disturbing the lacrimal gland at the time of surgery. It has everything to do with compromising orbicularis oclui muscle function by surgery. When incisions are made through the orbicularis oclui muscle, the function of this muscle is eyelid closure and it can be permanently effected by surgery. For individuals very concerned about or at risk for dry eye, depending on your surgical needs, the best option is to avoid procedures that cut through the orbicularis oculi muscle: Skin only lower and upper eyelid surgery preserving the orbicularis oculi muscle. Other options include lower eyelid transconjunctival surgery or chemical peels to remove lower eyelid rhytids.
Dry eyes from Blepharoplasty