Lower Blepharoplasty Transconjunctival Incision and Contact Lenses for Astygmatism - will the incision impact contact lenses?

Question

My eyesight is astygmatic, so I wear specially made contact lenses which rotate by gravity to the exact right position in my eye for me to be able to see clearly through them. One time I had conjunctivitis on the inside of my eyelid and the bump was preventing the lens from rotating properly, so I could not see out of that eye clearly. If a conjunctiveal incision is made it on the inside of my eyelid during a lower blepharoplasty, will the incision be low enough inside the conjunctiva to where the scar will not touch the edge of my contact lens? Or, if it will touch, will the incision heal flat, or with bumps? In other words, should I worry about never being able to wear my lenses for astigmatic eyesight agaim if I get a lower blepharoplasty with comjunctiveal incisions?

Carl Truesdale, MD · Answer

Good news &mdash; the transconjunctival approach to lower blepharoplasty is actually the better choice for a contact lens wearer, and once healed it shouldn't interfere with your toric (astigmatism) lenses.
Why the transconjunctival incision is contact-lens-friendly:
The incision is made on the inside of the lower lid (the conjunctival surface), not through the outer skin. It's well away from the cornea, where your contact lens actually sits. The cornea and the optical surface of your eye aren't touched by this procedure.
The incision heals from the inside and doesn't leave an external scar. It also doesn't change the curvature of your cornea, which is what determines how a toric lens fits and rotates.
Timeline considerations:
For the first 1 to 2 weeks after surgery, you'll need to be out of contacts entirely while the lid heals and swelling resolves. Glasses only during this window.
Around 2 to 3 weeks, most surgeons clear patients to resume contact lens wear once the conjunctival incision has healed and comfort allows.
Toric lens rotation: Your astigmatism lenses rotate to a specific axis to correct your vision. The transconjunctival incision doesn't change corneal shape, so your lens axis and fit should be the same after healing as before. You shouldn't need a new lens fitting because of the surgery.
What can temporarily affect contact wear:
Post-op dry eye is common for a few weeks and can make lenses less comfortable. Preservative-free drops help.
Swelling can make the lower lid feel different against the lens edge temporarily.
Both of these resolve as you heal.
What to do: tell your surgeon you're a toric contact lens wearer before surgery and ask their specific timeline for resuming contacts. Also let your optometrist know about the planned surgery &mdash; they may want to check your fit around the 6 to 8 week mark just to confirm everything settled normally, though in most cases nothing changes.
Bottom line: transconjunctival lower bleph and astigmatism contacts coexist fine. The incision location is exactly why this approach is preferred for lens wearers.

Waylon Zeng, MD · Answer

Hi there thank you for your question. Mucosal lining like the conjunctiva and the inside of your mouth are actually really amazing at healing. Even when left open, the incisions will often times heal back together without any bumps, otherwise that would create some constant irritation with your eyeball! Typically, I recommend waiting about 3-4 weeks before putting the contacts back in; that way, the incision will be closed, and there wouldn't be a risk of infection or wound healing problems if the contact lens are in place. There should be an issue with specialty astigmatism lens. Hope that helps

Lower Blepharoplasty Transconjunctival Incision and Contact Lenses for Astygmatism - will the incision impact contact lenses?

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