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.

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