Is an eye shield importance for upper and lower blepharoplasty?

Question

My surgeon says he doesn't use protective eye shields. Should I be worried? I'm having uppers and lowers using the Transconjunctival incision method.

Frank P. Fechner, MD · Answer

Personally, I do not use eye Shields and upper blepharoplasty. Given that the eyelids are closed during this procedure, there is, at least in my mind, no good reason to use them.In trans-conjunctival blepharoplasty, I routinely use shields to further protect the cornea. If skin tightening requires incisions under the eyelashes, I do not use shields. In general, what your facial plastic surgeon prefers as his routine and time-proven approach needs to make you comfortable before undergoing eyelid lift surgery.

Adam Bryce Weinfeld, MD · Answer

For uppers they are not as important as for lowers.  With a transconj approach,  I would use them with rare exception.

Mehryar (Ray) Taban, MD, FACS · Answer

Shields are not necessary after blepharoplasty or most other eyelid surgeries. This provides the ability to perform surgery on both sides and the patient can see and function after surgery.  This is different than when having intraocular surgery such as cataracts.

Kenneth D. Steinsapir, MD · Answer

Eyelid surgeons who are not board certified in ophthalmology (e.g. general plastic surgeons, facial plastic surgeons, dermatologic surgeons) are very uncomfortable operating near the cornea surface.  They are also uncomfortable placing corneal shields on the cornea.  Oculoplastic surgeons are board certified ophthalmologists who are also fellowship trained in eyelid and facial plastic surgery.  They are very comfortable working near the eye.  They have been extensively trained to perform microsurgery on the eye itself.  Generally a corneal shield is not specifically needed for corneal protection.  The reason for this is simple.  When performing transconjunctival lower blepharoplasty exposure of the back of the lower eyelid requires the eyelid to be pulled gently away from the eye.  Also a retractor called an eye plate (think of a small flat spatula) is coated with opthalmic ointment and placed against the cornea,  The plate protects the eye and is also used to move the eye back to make the room necessary, in conjunction with the eyelid retractor, to carry out the surgery.  So protection of the eye is built into how this surgery is performed.Upper blepharoplasty usually does not require a cornea shield because it is considered sufficiently far away from the eye that it is not necessary.  However there are situations that change this.  Primarily if upper eyelid ptosis surgery is also performed at the time of upper blepharoplasty, a shield may be used to protect the cornea when sutures are being placed in the upper eyelid tarsus.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Every surgeon has his or her preference. I typically use a shield to protect the eye during surgery.  If your surgeon has vast experience performing his/her surgery this way without major eye complications then you should be in good shape.Earl Stephenson, Jr, MD, DDS, FACS

Harlow Hollis, MD · Answer

I try to do my surgery and keep the patient safe at the same time. That said, I do not use eye shields during upper or lower blepharoplasties that are done via the skin route. Always use them though for all eyelid surgery done with lasers and with lower blepharoplasties done trans-conjunctivally. However eye shields themselves can scratch the cornea so make sure they are well lubricated to diminish this risk.

William Portuese, MD · Answer

Shields are absolutely necessary if you're having  laser work anywhere close to your eye. In our practice, we do  not use eye shields when performing a blepharoplasty.  There are too cumbersome and we have actually seen scratches of the cornea even while using them.

Stephen Weber MD, FACS · Answer

My personal answer is no but you will likely see different responses here on RealSelf and during consultations. There are strong proponents of either practice and this is often based on training - what our mentors taught us to do, we continue to do. As far as I am aware there are no data or study results to suggest that one practice is superior to another. As with your question on anesthesia, if you trust your surgeon and they are experienced and produce great results, I would recommend following their advice.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

John Frodel, MD · Answer

First and foremost, your surgeon must be aware of the risks of injuring the eye during eyelid surgery.  But whether they use shields (corneal protectors) is just an option.  Corneal injury can occur from the shields themselves if not used properly.  Another issue is anesthesia---under general anesthesia or even deep IV sedation, the patient may not be able to tell the surgeon that the eyeball hurts, whereas with lighter anesthesia, just like when you are awake, the patient will know if the eye is being touched.  So awareness of the surgeon is what is most important in preventing eye injury.  I am sure that your surgeon is quite aware of preventing injury.  Good luck!

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

Thank you for your question.  Even with the greatest care there are many possibilities for eye injury from instrumentation or lasers during eyelid surgery.  In my opinion corneal shields should always be used during blepharoplasty surgery.

Is an eye shield importance for upper and lower blepharoplasty?

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