Tear Production After Lower Blepharoplasty

Does tear production levels usually go back to normal after any type of eyelid surgery, such as upper bleph, levator resection, or a combination of both? Unfortunately I didn't have Schimer's tear test done before mines, as did not have dry eye. But my Schimer's test shows dry eye now (had test done 3 months after). I'm just wondering whether if surgeons have encountered patients with lower tear production (ex schimers) after similar surgeries and in their patients cases, the recovery time

Doctor Answers (7)

Dry eyes after eyelid surgery

+2

I noticed your title mentions lower blepharoplasty but you refer to upper bleph and levator resection in your question. I agree with Dr Steinsapir that the most frequent cause of the problem is underlying dry eye that existed prior to surgery. If we look specifically at upper eyelid surgery (blepharoplasty and particularly levator resection), it is very common to have eyelid closure problems in the early post-operative period. The fact the eyelids don't close properly dries the surface of the eye because blinks are no longer able to properly rehydrate the eye completely after tears evaporate, leaving the bottom portion of the cornea constantly exposed to air. This will definitely exacerbate an already dry eye and can even cause problems in patients with normal tear production. Thankfully, as swelling decreases, and tissues become more supple, the eyelid will almost always regain it's ability to better distribute tears over the eye. Since this can take a few weeks, it is often recommended to use lubricating ointment up to every hour during the day and before going to sleep. Good luck!


Montreal Oculoplastic Surgeon
5.0 out of 5 stars 1 review

Change in eyelid shape after lower eyelid surgery only a part of the problem.

+2

Dear CoolGuys

Dr. Moelleken is correct in identifying changes in lower eyelid shape as a factor in dry eye after transcutaneous lower eyelid surgery.  However, this is not the most frequent cause.  By far the most frequent cause is: 1) underlying dry eye that existed prior to surgery and 2) Inadvertent surgical damage to the motor nerves that supply the lower eyelid orbicularis oculi muscle along the lower eyelid margin.  This muscle is very important to moving and distributing tears over the ocular surface.

While it should be routine to measure tear production prior to eyelid surgery, many surgeons forego this step.  There are a small percentage of individuals whose dry eye is so severe that eyelid surgery should not be performed but it is rare (but not unheard of)  for this level of symptoms to result just form the actual eyelid surgery.  Typically, dry eye symptoms will be present for 6 to 8 weeks after surgery before resolving.  During this time frame, artificial tears and bedtime bland ophthalmic ointments can help.  If your dry eye symptoms have persisted past this time frame, it is reasonable to consult an oculoplastic surgeon or cornea specialist regarding further measures to increase eye comfort.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

Dry eye after lower blepharoplasty

+2

Hopefully your dry eye will improve on its own with conservative care.

The most frequent cause for dry eye after lower blepharolasty with a subciliary incision is change in eyelid shape, usually with rounding of the eye or pulling down of the corners. There is often overexposure of the white portion of the eye, causing a reflex increase in tear production. 

We typically improve this shape, if it is indeed needed, at the 6 month mark with a short incision cheeklift, with correction of eye shape and canthal adjustment.

In any event, we almost always wait a full six months and try conservative care prior to considering any revision.

You may wish to talk with your doctor about these options.

There are some publications on the subject referenced below.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

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DRY EYE SYMPTOMS

+1

It is not uncommon for tear production to be altered temporarily after eyelid surgery.  If after 3 months lubrication has not helped, I would recommend a consult with an ophthalmologist. He may be able to help you by inserting plugs into the tear ducts.  This will allow the tears to bath the globe more efficiently.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.5 out of 5 stars 8 reviews

Dry eye will typically improve after blepharoplasty

+1

Your dry eye should improve with time. In the meantime, be vigilant with lubrication and moisture of your eye to prevent injury from excessive dryness. Also, keep your plastic surgeon informed of your progress.

Best,

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 36 reviews

Lower blepharoplasty and tears

+1

Tear production can be affected by a blepharoplasty ans usually gets better over time. Continue with eye drops and/or creams asyou are instructed by your doctor.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Tear Production After Lower Blepharoplasty

+1

What you describe is too common. Local care for a few months will help correct this issue. Best of luck from MIAMI Dr. Darryl j. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 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.