Red, Dry Eyes After Blepharoplasty and CO2 Laser

Question

I had a transconjunctival Blepharoplasty on lower lids combined with CO2 laser 15 days ago. Both lower eyelids appear to be standing away and downward from the eyeballs, and there is a dry, uncomfortable sensation.  In addition, my eyes are consistently red.  Is this an example of retraction, or is it too early to tell?

Steven H. Williams, MD · Answer

Thanks for your question -
Your description could represent a significant problem.  The issue is corneal exposure.  If you can't protect your cornea you could have significant issues with corneal abrasion that could even affect your eyesight.
The cause of this could be lower lid retraction or it could be that you had some lower lid laxity that is now exacerbated.  These issues may get better without intervention but it is critical that steps be taken to protect your eyes while things are healing.
In addition, if this is a persistent problem you may need a temporary procedure to give additional support to your lower lid or a canthopexy (a permanent procedure to tighten the lower lid).
In any case you should talk to your surgeon about these issues as soon as possible.
I hope this helps.

Anil R. Shah, MD · Answer

Any patient with dryness after a blepharoplasty should seek immediate medical advice.  Dryness after blepharoplasty can lead to a host of problems including corneal abrasion.

Lubrication with an ophthalmic recommended by your surgeon, artificial tears, and possible manual manipulation of the lower lid are some possible early solutions to dryness.

Steven Wallach, MD · Answer

It sounds like you may have lower lid restriction. When the eyes can't close well, they can get very dry. Also when a transconjunctival bleph is performed, it affects the lymphatic system, which may cause chemosis and this can lead to dry eye and redness. Use lots of lubricants, massage the lower lids, and follow carefully with your doctor.

Robert M. Freund, MD · Answer

Use Genteel eyedrops and lower lid exersizes to loosen up the scar tissue and edema.
Before you perform any procedure on your lower eyes, consult with your doctor, but I routinely tell my patients to tightly squeeze their eyes shut and hold them in place for 5 seconds. The muscle movement will tighten the lids and help squeeze out some of the fluid that weighs down the eyelids.

Kenneth R. Francis, MD, FACS · Answer

Suzy,
You undoubtedly still have swelling from your procedures.  You need to lubricate your eyes with an ophthalmic ointment at night and eye drops during the day.  You should see your surgeon for further guidance.  Good luck!

Jeffrey Zwiren, MD · Answer

From your description it sound like you have, at least, an early exposure problem. You should contact your surgeon about your symptoms and protect your eyes from over exposure. Eye lubricants like refresh plus or gentel can help alleviate the dryness until the early skin contracture and pulling down of your lids improved.

Robin T.W. Yuan, MD · Answer

The fact that you yourself have noticed that the lower eyelids are not in contact with the sclera and have fallen downward is significant. Lid retraction might be temporary but you can still damage the cornea if you have constant lagophthalmos, or inability to completely approximate the eyelids, especially at rest. A slight degree of lower lid tightening or swelling or scar retraction can produce this in certain individuals with lack of lower lid support to begin with. You need to check with your surgeon and perhaps with an eye specialist to see if you have lagophthalmos, especially when sleeping, and if you have corneal abrasions or dryness from exposure or disruption of tearing dynamics. If you cannot see your doctor right away, I would suggest using eye drops during the day and ophthalmic ointment at night as a precaution until you can see a specialist.

Brooke R. Seckel, MD, FACS (retired) · Answer

What you are describing sounds like retraction of the lower eyelid after blepharoplasty and CO2 laser resurfacing.
The eye must be kept moist and not allowed to become dry.
Simple taping of the eyelid with steri strips may be sufficient to keep the eyelid tight against the eye until the swelling has subsided however this may be impossible because of the resurfacing wound.
A simple effective prcoedure called a temporary tarsorraphy in which a small stitch is placed into the corner of the eyelids will pull the lower lid up against the eye and protect the eye until the swelling and lid retraction has subsided.
See your doctor, do not wait.

Marc Cohen, MD (retired) · Answer

The changes that you are seeing is most likely a result of the CO2 laser treatment to your skin.  A transconjuctival blepharoplasty should not cause any change in your eyelid position.  Most likely the skin around your eyes is still swollen and stiff and this will get better over time.  Make sure you do careful follow up with your surgeon.  
In the mean time keep your eyes well lubricated with over the counter artificial tear drops (use a drop four times a day) and use an artificial tear ointment in your eyes at bedtime.  Don't be fooled by the fact that your eyes may be  tearing a lot.  They are dry and lubrication will protect them as you heal.

Red, Dry Eyes After Blepharoplasty and CO2 Laser

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