Dry Eye - Temporary or Permanent After Upper Bleph?

Dry eye after blepharoplasty or ptosis surgery is usually temporary.  Tears are made up of three components, water, oil and mucous.  The oil and mucous components of the tears originate mostly from the smaller glands which are located in the lid margin.  Swelling will cause these glands to function poorly in the immediate post-operative period resulting is dry eye symptoms.  Tearing is a paradoxical effect.  The brain will sense that the eye is dry and cause the lacrimal gland to secrete more tears.  Problem is that these tears are more water in content and therefore do not have the same quality as normal tears and are less effective at lubricating the eye. 

Dry eye that is permanent is usually a result of too much skin being taken in the case of blepharoplasty or the muscle being shortened too much in the case of ptosis.  Excesses however are relative and what is too much in one patient may be just right in another.  Pre-existing dry eye patients may be at a much higher risk of this and need to have more conservative surgery to protect the eye.  Lasix may also pre-dispose to dry eye and blepharoplasty should not be undertaken within 6 months or so of this procedure. 

Usually selecting a surgeon who will pay attention to the patients pre-operative eye condition and perform a procedure that is conservative enough for that patient will prevent permanent dry eye from occurring. 

It's not unusual for patients to develop eye dryness following blepharoplasty surgery. In most cases, this problem resolves in 2 to 3 weeks, but in rare cases may persist for longer periods of time. In some cases, eye dryness may even be permanent.A variety of factors can contribute to eye dryness. These include skin tightness, muscle weakness, ectropian formation and damage to the lacrimal gland. It's important to address these problems as soon as possible to avoid inflammation and damage to the cornea.The vast majority of patients respond to conservative management. This typically involves the use of drops and lubricants. In some cases, it may be necessary to use lacrimal duct plugs.If dry eyes develop following blepharoplasty, it's important to maintain close contact with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses this problem.

It is quite common to have some dry eye symptoms after an eyelid lift (blepharoplasty). The inflammation after surgery can lead to reduced tear production and dry eyes. This is temporary in the vast majority of cases. While rarely possible, lasting dry eyes can occur. This may be due to inflammatory changes to the lacrimal gland. In nearly all cases dry eye is temporary and can be improved with lubrication like natural tears and/or eye ointment. By using lubrication in the healing phase you can avoid dry eye symptoms and allow your eyes to return to their normal state comfortably.

I hope this info helps!

The most important step in preventing postoperative complications with dry eyes after surgery is not the surgery itself or how much skin is removed.  

Three steps to avoiding dry eyes after eyelid surgery:


 The most important step is  a good medical history Medical History.  The surgeon should find out         whether you have any history of dry eyes or have been treated for conditions related to dry eyes.  Do you frequently use moisturizing eye drops.  Have you had Lasik surgery which can decrease the sensitivity of the eyes and place you at risk.  Have you ever been treated with punctual plugs or Re-stasis for dry eye conditions.  Thyroid disease, Sjogren's syndrome can also contribute.  And the most important of all.  Have you had previous eyelid surgery.

If your eyes are dry for any of the above reasons it is important that you have a thorough ophthalmologic exam including a slit lamp exam and schirmer tear test prior to any eyelid surgery.  These are important tests to help determine if your eyes are too dry for eyelid surgery.

If your are a reasonable candidate based on the History and Physical exam above then seeking out a skilled surgeon who will not remove too much skin and using eye drops (Refresh Plus) for a few weeks after surgery will protect you from dry eye complications.


Follow the above steps and you will not have to worry about the possibility of long term dry eyes

Dry eye can happen after upper Blepharoplasty but it usually resolves after the initial healing. There are however people who have dry eye condition before an upper Blepharoplasty is done and if such condition exists then an upper Blepharoplasty should not be done. The dry eye syndrome, if not treated, can cause the cornea to scar and cause blindness.

So this is a matter of finding out if the patient suffers from dry eye before the surgery. A Schirmer test can be done in the office to check for the tear production and to rule out dry eye.

Dry eye is not an uncommon complaint after upper eylid blepharoplasty, but it is almost always temporary and is related to the inflammation of the healing process and/or temporary inability to fully close the eye (especially at night). It is important to properly lubricate the eye during the healing process to minimize this symptom.

Long term dryness is very unusual, but in situations where eyelid ptosis is repaired, it can occur due to the fact that more of the eyeball is exposed now that the ptotic or droopy eyelid is now in a normal position. The actual surgery did not effect the tear production, or cause a dry eye, it only allowed for more exposure of the eyeball which can lead to more significant loss of tears due to evaporation.

Ultimately, upper blepharoplasty is an extremely safe and effective procedure when performed by an experienced surgeon.

Andrew C. Campbell, M.D.

Board Certified Facial Plastic Surgeon

It is actually very normal to experience dry eye in the early healing period after eyelid surgery.  There are a number of reasons for this but the bottom line is that it is usually self-limited and improves over a short period of time. 

That being said, artificial tears can be quite helpful during this time to alleviate the dryness.  Whatever you do, avoid Visine since it can tend to irritate your eyes with repeated use.

I hope that helps!

It is completely normal for your eyes to feel dry after surgery because the tear film is thinner and blink reflex is decreased.  It is important to use a lot of artificial tears during the post operative period for lubrication.  After a couple weeks, the eyes should be feeling better.  Pre-existing conditions such as decreased tear production can have an effect on the outcome so if you feel like your eyes are dry before eyelid surgery it is best to have an opthamologist evaluate you prior to surgery and discuss your history with the plastic surgeon.  Long term dry eye is usually due to a condition not identified before surgery.  Rarely it would be due to having too much skin excised, but the use of a qualified plastic surgeon should minimize that risk.  Best of luck to you.

Hi LA,

Permanent dry eyes after blepharoplasty should be very rare.  Patients are evaluated before surgery to insure that pre-existing dry eye is not exacerbated.  You have done your research very well, all of the reasons that you mention in your question can lead to dry eyes after bleph.  Now continue your research and choose your blepharoplasty surgeon most carefully.  Good luck and be well.

Dr. P

Encino

FIrst, because you live in Los Angeles, you are by necessity extra paranoid.  Hi neighbor.  

Your dry eye status can be assessed prior to surgery.  However, even the driest eye person can have an eyelid surgery tailored to their particular situation.  It is helpful to assess and be acutely aware of unusual dry eye situations.  If you are relatively young, healthy, and don't have a preexisting dry eye issue, you are likely to do fine with a properly done blepharoplasty.  

While there are surgeons who actually take out too much skin and this prevents normal eyelid closure, this type of extreme result is not the most common reason someone might experience long term dry eye after eyelid surgery.  The most common reason in my experience is also not preexisting dry eye.  The most common reason for persistent dry eye after blepharoplasty is damage to the motor nerve fibers that supply the orbicularis oclui muscle overlying the upper eyelid and lower eyelid tarsus.  This is the nerve supply to the part of the eyelid muscles that are responsible for blinking the eyes.  WIthout a brisk natural blink, tears are not properly spread over the surface of the eye leading to long term dry eye symptoms.  These motor nerves never grow back.  Most surgeon who cause this problem have absolutely no insight as to what is causing their patients symptoms.  This is primarily because these surgeons are not ophthalmologists but ophthalmologists can also lack appropriate insight into this issue.

The answer is to find a surgeon who very much understands these issues and addresses the problem with you at the time of your consult and designs surgery to reduce the risk of this complication.