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.

There are several causes of dry eye after blepharoplasty- including failure to identify this ahead of time, excess upper eyelid skin excised, scarring of the lower lid septum, and injury to the lacrimal gland. We are taught to always avoid resecting excessive upper eyelid skin to prevent this from happening, and to be quite honest, I have no personal experience to tell you whether this is in fact permanent.