Will Bleph Effect Dry Eyes Problem?

Male 59 years considering Quad Bleph. I have had dry eye problems for several years, would this procedure effect that one way or the other? Thanks, Rob

let me know if additional information is required

Doctor Answers 18

See an ophthalmologist

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If you have dry eyes and you are considering blepharoplasty, it may be helpful to have an ophthalmologic exam prior to your surgery. While certain procedures can help, it is also possible that blepharoplasty could worsen the symptoms. Just make sure you explore all your options before having surgery.

More related to the extent of dry eye that you have

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Blepharoplasty will certainly not make your dry eye better. However, you may have to increase your use of artifical tears for several weeks; your ultimate need for the tears may not significantly change once you've recovered from surgery. I've done several patients with this problem and all have returned to their pre-op use of the tears.

Alexander M. Guba, MD
Huntersville Plastic Surgeon

Could make it worse except in one case!

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In general Quad bleph will not improve dry eyes and could make your dry eye condition worse. Any patient with dry eye is a relative contraindication for blepharoplasty or at least the plastic surgeon need to proceed with extreme caution.

However, there is one condition that might benefit from lower bleph if the desired effect is to raise the lower lid to cover a greater portion of the cornea. It must include a canthopexy or canthoplasty to maneuver the ligaments that support the lower lid. This procedure must be done with a plastic (or occuloplastic) surgeon very comfortable with occuloplastic techniques. It is a narrow indication and might only help if someone already got some anatomical exposure.

Good luck!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Dry eyes and blepharoplasty

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Undergoing either upper or lower blepharoplasty can exacerbate existing dry eye symptoms. Before any plastic surgery is performed, a thorough evaluation by an ophthalmologist is warranted to assess the severity and possible cause of your symptoms. That will allow a dialogue between you and your surgeon about the safety of undergoing blepharoplasty. 

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Blepharoplasty for Dry Eye Patients

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The fact is that a sizable minority of patients having functional upper lid Blepharoplasty in their 60's have some degree of dry eye issues.  The reason for this is that baseline tear production naturally decreases with age.  In fact, many patients present with what they describe as "wet eyes".  This relates to decreased baseline tear production, which stimulates occasional reflexive tearing.  Truly significant functional dry eye issues tend to occur in patients who have a) severe dry eye issues prior to surgery, b) upper lid skin resected at the time of surgery, or c) Both a and b.  My rule of thumb is that any patient who is able to wear contacts does not have dry eyes.  My second rule of thumb is that any patient who cannot make it for 3-4 hours without using artificial tears should probably not have surgery.  My third rule of thumb is that removal of upper eyelid skin should always be judicious (the "pinch" technique).  I concur with the advice above that any "dry eye" patient considering upper eyelid surgery should consult with an Ophthalmologist.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Eyelid surgery might aggravate dry eye syndrome.

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Eyelid surgery can aggravate dry eyes especially in the short term.  I have my patients see an ophthamologist prior to any surgery to evaluate the magnitude of the problem and the plan to treat problems if surgery is performed.  Occasionally the ophthamologist will advise against surgery.

Blepharoplasty can make dry eyes worse.

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I wouldn't say absolutely that you cannot have blepharoplasty done, but you need to be very careful.  It must be done conservatively, by a real expert, and the lower lids need to be perfectly supported. I would consult two different ophthalmologists.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Blepharoplasty should not be done on patients with Dry Eyes Syndrome

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Dry eyes are a serious contraindication for blepharoplasty. Excess skin is removed during blepharoplasty which tends to open the eye, exposing the eye to more air which has a drying effect and can make dry eyes worse.

Serious dry eyes can lead to damage to the cornea a very serious condition.

Lower blepharoplasty done through an external eyelid incsion is a particular risk. Often the incision weakens the eyelid, a condition called ectropion in which the lower eyelid droops down in a sad eyed look. This situation can greatly increase dry eyes and requires surgical correction. Modern transconjunctival blepharoplasty through an internal eyelid incision lessens the risk of ectropion.

Not all dry eyes are severe. To determine if you can have a blepahroplasty, see your ophthamologist who can do a tear production and tear quality test to see how severe your dry eyes are and whether you can have a blepharoplasty.

Consult your ophthalmologist

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There is a 2% to 3% chance that performing a blepharoplasty will indeed make your dry eyes worse. Make sure that a portion of the orbicularis oculi muscle on the upper lids is not removed. Check with your ophthalmologist and document the amount of dryness in your eyes and give some consideration to both eye drops and silicone ductal plugs, which can help with the dry eye.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Dry eyes is a warning

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You can dry eyes for many different reasons. But if dry eyes is a result of a functional problem with your eyelids then these problems should be evaluated and treated. If you have dry eyes because you produce small amounts of tears, then any surgery should be minimal to avoid any pulling on the upper or lower eyelids. In this case, less is more!

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 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.