Itchy, Burning Eyes 2 Months After Blepharoplasty

Dear Santa Barbara

Dry eye after blepharoplasty is well described.  Some eyelid surgeries are more aggressive than others and can cause more dry eye symptoms.  So while it is true that dry eye symptoms do generally settle down within 4 to 6 weeks, this assumes that an aggressive lower blepharoplasty was not performed.  These procedures can damage the muscle the helps blink the eyelids and helps close the eye.  Similarly an upper blepharoplasty generally has no bearing on eye comfort after this time period unless aggressive work was performed to reduce the redundant skin and muscle in the upper eyelid.  General ophthalmologists are not always a focused on corneal drying as they should be.  Certainly the recommendation of using drops twice a day is not that helpful.  Also the contact wetting solution is not optimal.  A cornea specialist will be much more attuned with you dry eye concerns and have a more comprehensive approach to making the eyes more comfortable.  

Most patients have some issues with dry eye after any eyelid surgery.  The glands that make our tears are located in the eyelid, and the inflammation of the surgery can alter the production of tears.  For that reason we recommend using an artificial tear at least 4 times a day.We lubricate the cornea with our blink which can be altered after the surgery.  This is especially true in people who have some lid retraction of the lower lid.  If you have that, it can take a while for the lid to return to a normal position.  Try using an artificial tear ointment at bedtime - this can make the eyes feel better throughout the day.  It may also be too soon to be wearing your contacts as they can be irritating to a dry eye. 

It's not unusual for patients to develop dry, burning, itching eyes 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.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 plugs.It's important to maintain close contact with your plastic surgeon. If you fail to see improvement, it might be appropriate to consult an ophthalmologist as well.

Having some dry eyes is not uncommon after upper eyelid blepharoplasty and/or ptosis surgery.  The eyes are more open from these surgeries and hence, the eyes get more exposed to air, and get dryer.  Using frequent lubrication is recommended.  There are other options as well.  Recommend evaluation by an ophthalmologist and/or oculoplastic surgeon.

Dr Taban

Here are a couple of things to think about:

1. You should stop wearing contact lenses until your situation resolves.

2. It sounds as though you may be allergic to the lubricants you are placing in your eyes.

I think you should stop all drops, etc., and arrange to see an ophthalmologist as soon as possible.

While you are waiting for your consult you might consider taping your lids closed overnight to keep your corneas from drying while you sleep.

Good luck!

Dry eyes after blepharoplasty are not uncommon leading to dryness and irritation of the vulnerable cornea, due in part to temprary incomplete lid closure and  incomplete muscle function.  If you had a preexisting dry eye tendancy, the symptoms can be even worse.  To treat your irritative symptoms and prevent severe inflammatory changes of the corneal surface, it is most important to protect your eyes from drying with frequent eye drops during the day and soothing eye ointments at night, eye squeezing and massage exercises as well as possible temporary taping your lids closed at night or even temporarily partially suturing your lids.

You should consult frequently with your surgeon as well as an opthalmologist who will help with management and treatment suggestions.  Often times, the condition can be self-limited and although 10 weeks seems like a long time, it can occasionally take several months to normalize to your baseline.