Bloodshot Eyes After Blepharoplasty Surgery

Dear Brown Eyed Girl,
It's been awhile since you posted. However, what you are describing with eye irriation is presumably dry eye after eyelid surgery. Generally, we tell our patients that this can persist for 6 to 8 weeks.
It is a good idea for your surgeon to assess the ability of the eyes to produce tears and any evidence of a base line dry eye condition. This does not prevent people from having eyelid surgery, but it should guide the doctor in preparing the patient to know what to expect after surgery.
Swelling of the eyelid can worsen dry eye. Generally, when the eyes are so dry that the conjunctive is red and irritated, dry eye treatment should be aggressive. This treatment is best directed by an eye plastic surgeon or a general ophthalmologist, and when needed, a cornea specialist. It is my experience that when the eyes are this irritated there are also dry spots on the actual corneal surface.
Also, be aware that occasionally we find that patients who experience irritation after surgery and have been diligently using eye drops or ointment recommended by the doctor, can have an allergy to some of the ingredents in the products. Treatment early after surgery is supportive.
If the individual is using an ophthalmic product known to cause irritation, this is stopped. Even the best artificial tears only last about 40 minutes, so it is not uncommon to recommend artificial tear every one or two hours while awake. Non preserved tears are often preferred to reduce the risk of allergy to the preservative. At bed time the drops don't last long enough and bland ophthalmic oinment is prefered.
When the eyes do not close after blepharoplasty or the muscle of the upper eyelid closed to the lashes does not generate enough force (which occurs if the motor nerves to the muscle are damaged due to the surgery) more aggressive physical measures may be recommended. This can include taping the eye closed or an occlusive chamber. Generally, these measures are only recommended in extreme cases and should be guided by an eye plastic surgeon or general ophthalmologist.
Frequently, there are also eyelid margin conditions that can be optimized including treating inflammation along the eyelid margin such as blepharitis. The tear drainage system can be temporarily occluded when necessary.
The bottom line is that these symptoms should resolve 6 to 8 weeks after surgery. Symptoms beyond that should be carefully assessed and this assessment will often be outside the scope of practice of a general plastic surgeon or facial plastic surgeon. Consequently, it may be necessary to consult with a fellowship trained eye plastic surgeon or your general ophthalmologist.

It's not unusual for patients to have bloodshot eyes following blepharoplasty surgery. this can occur for a variety of reasons including allergies, corneal abrasion, infection, medication reactions and eye dryness. In most cases, post-operative redness resolves with conservative management.





Your history suggests that you've had significant eyelid drying from your space heater and from viewing your computer screen. Under these circumstances, it's important to make sure your eyes are adequately moisturized.





When these steps are taken, eyelid redness gradually resolves without consequences. If you're concerned about bloodshot eyes, it's appropriate to consult your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your concerns.

Redness of the eyes may not be related to your surgery. Since you had no pain, it will probably resolve without treatment. If you felt irritation, then dryness would be high on the list of possibilities. If it does not resolve, follow up with your surgeon. Try refrigerating and using chilled artificial tears in the meantime.

This is not at all unusual and is most likely related to the increased circulation to your eyes from the surgery.
It can be made worse if your eyes become dry so be sure to use ocular lubricants liberally during the first 3 weeks.
If your eyes become inflammed you may ask your physician for an Acular prescription, it is costly, but it is a non-steroidal anti-inflammatory that can reduce the redness and irritation.

it is very common to experinece dry eye, irritation, redness, itching, and tearing after lower blepharoplasty for several months after surgery. this can be worsened by heavy computer work, heat, and windy environment.
Lubricating eye drops, anit-inflammatory eye drops, cold compresses, and most importatnly REST, are very helpful.
be patient because eyes are very sensitive, and this will persist for several months.
yours,
sean younai, MD, FACS,