Canthopexy and dry eye? (Photo)

Question

It's been 8 months after upper and lower blepharoplasty. Before the surgery my eyes was almond shape and after the surgery my eyes appear round shape and extremely dry. I have been using artificial tears, ointment at night, Restasis, but no relief. My ophthalmologist inserted tiny silicone plugs in my lower tear ducts, it helped for a few weeks and now is back being dry again. My surgeon recommended to have Canthopexy? Is this procedure would help with my dry eye condition?

Kenneth D. Steinsapir, MD · Answer

It will enrich your surgeon but based on the photos, I do not see anyway that tightening your eyelid will help your dry eye.  Generally blepharoplasty makes dry eye worse by weakening the muscles that blink the eyelids closed.  Tightening the lateral canthus does not make this situation better and the inflammation that it stirs up can actually make you more uncomfortable.  Consider trying Xiidra as an alternative to Restasis.  I would get more opinions before having more eyelid surgery.

Mehryar (Ray) Taban, MD, FACS · Answer

Not sure if you need canthopexy. Best to see an oculoplastic specialist for personal evaluation. The answer may or may be more surgery.

John A. Standefer Jr., MD, FACS · Answer

Dry eyes are common after blepharoplasty. The dryness usually improves with time and resolution of the swelling, especially the swelling in the lower eyelid muscles that hold the lower lid up against the eyeball. For our tears to be efficient, the muscle has to hold the eyelid up against the eyeball. If the lid pulls away even a fraction, the tears don't lubricate the entire eye adequately and the symptoms begin. Reinforcement of the lid with a canthopexy or infrequently with a lower eyelid shortening, can often relieve the symptoms of dry eyes. The artificial tears during the daytime, the lacrilube at night,  and Restasis are all helpful for eye comfort and may be necessary even with the canthopexy or lid shortening. A thorough exam to determine the strength of your lower eyelid will determine which approach will get you the results that you desire. John Standefer MD

Michael McCracken, MD · Answer

I would need to see you in person to determine if a canthopexy would help your condition, but it often can help dry eye after blepharopalsty.  If the punctal plugs did help initially and are no longer helping, it is possible that they could have fallen out.  You might see your ophthalmologist to see if you would benefit from having plugs placed again.

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. I am sorry to hear about your concerns. Dry eyes after blepharoplasty is not uncommon, but it should not be lasting as long as 8 months. Based on your description, I think that a canthopexy may help with your symptoms. However, it would help to have your before and after photos, and know what was done during the surgery. Finally, you absolutely need to be evaluated in person. Any surgical decision should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck! 
 
 Best,
  
Jon Ver Halen, MD FACS 
 Harvard educated plastic surgeon

Canthopexy and dry eye? (Photo)

Answers (5)

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