Will Bleph Effect Dry Eyes Problem?

Rob,
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.

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. 

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.

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.

Every eyelid surgery candidate should have a full ophthalmic exam prior to under going this rejuvenating procedure. As an Ocular Plastic Surgeon I examine and review several aspects of the patient's eyes prior to surgery.
It may not be enough for your cosmetic surgeon to only look at your eyes at a distance. The eyelids and eyes must be checked for several conditions that could effect your happiness in regard to your surgical outcome. Your physician must check the height, contour, and muscle strength of the lids. For example if your eyelids do not fully close prior to the procedure or the lid is weak or "floppy" you may have problems with tearing or irritation after the surgery.
The front of the eye, the cornea, must be healthy and this includes a good tear film. This can only be checked by a slit lamp exam. If your eyes are dry, you may still be able to have the procedure. If they are severely dry or you have corneal problems, you may end up with tearing problems.
After eyelid surgery more air can hit off the eye worsening a dry eye or corneal problem. It is very important for patients who have had refractive surgery (LASIK) to have an ophthalmic evaluation prior and these patients are more prone to tearing problems. One of the most important tests is a Schirmer test which can be used to predict a dry eye problem. Ocular Plastic Surgeons check all of these factors prior to perfoming blepharoplasty.

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.

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!

Taking a history regarding dry eyes and performing a Schirmer's test on physical exam are important parts of evaluating patients seeking blepharoplasty. That is because blepharoplasty may worsen existing dry eyes or cause it in patients who didn't have it before surgery. The opthalmologist should rule out any diseases contributing to dry eyes and can prescribe a regimen to minimize the problem before surgery. The surgery itself may need to be more limited in aesthetic goals so that ocular dryness is minimized postop. Thank you for bringing up an important issue for patients considering blepharoplasty.

Blepharoplasty can affect dry eyes, so this is something you need to discuss in details with your surgeon. If too much skin is removed on the top, you might not be able to close your eyes, making them even drier, leading to exposure keratitis, and potentially more problems.
Similarly, if too much skin or muscle are removed on the bottom without proper realignment and suspension techniques, your eyes appearance and health might be adversely affected. Oculoplastic surgeons are usually well trained and qualified to deal with patients with dry eyes and can advise you on how to proceed.
Alternatively experienced facial plastic surgeons and general plastic surgeons may be a good resource for you as well. They will usually refer you to an ophthalmologist for further evaluation and necessary treatment for dry eyes prior to surgery.

Dry eyes following blepharoplasty can be a bad problem and should be avoided if at all possible. There are several points to consider:
1. Discuss your dry eye problem with your plastic surgeon and be sure that he understands the degree of your dryness.
2. It may be advisable to see your ophthalmologist prior to your procedure to check the degree of your eye dryness. There is a test called a Schrimer’s test that can be done to determine how you are producing tears.
3. It is important to understand and degree of sagging or loss of elasticity of your lower eyelid. The lower eyelid acts as a sling and is suspended from either side of the bony orbit by a ligament. It is important that during a blepharoplasty surgery a condition known as ectropion is avoided. This is a downward pull of the lower eyelid. This can leave the eye and cornea exposed and can lead to an abrasion or ulceration.
4. Your surgeon will test the degree of elasticity of your lower eyelid by pulling it out and pulling it down. If there is excess laxity in combination with a pre-existing dryness extreme caution must be used as there is an increase likelihood of postoperative dryness. This can be at least partially avoided by performing a lid tightening procedure such as a canthopexy or canthoplasty.
5. Get evaluated first by both an experienced plastic surgeon and an ophthalmologist. Understand the possible consequences of post operative dryness and if you proceed with the blepharoplasty may consider doing only the uppers first followed by the lower lids at a second session. There is nothing more miserable that post blepharoplasty dry eye syndrome especially if it can be avoided by being conservative.