Lacrimal Gland Injury?

if, say, lacrimal gland/ductules are injured during ptosis surgery/upper eyelid bleph, does it end up healing on its own? I am nervous because my dry eye hasn't been going away and is quite low tear production even after many months, but my surgeon cant identify whats wrong? Do I need the help of an oculoplastic?

Doctor Answers 7

Lacrimal Gland Injury?

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Only for your peace of mind, YES,  get a second in person eye opinion. From MIAMI Dr. Darryl j. Blinski

Lacrimal gland injury

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If a ptosis repair was performedn, the likelihood of a lacrimal gland injury is extremely low.  On the other hand, a blepharoplasty can cause dry eye and lubricants can help until the eye improves with time. If not you will need to see your ophthalmologist.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Dry Eyes after Blepharoplasty

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In 30 years of practice I have never seen a dry eye after blepharoplasty that did not resolve and become normal.  It is important to check to see if dryness is present pre op.  If eyes are very dry pre op a more conservative procedure is indicated.  Lacrimal gland injury is very rare.  You will be fine but it may take 6 months.  If the dryness persists visit you local opthalmologist and get an  evaluation and other care suggestions.  Keep your room humidifyed at night.  Dry room = dry eyes.  Use Refresh drops in day and Celluvisc at night.  Wear glasses with lateral shields when you are in sun or wind,   (REI has these shields for mountain climbers)  Opthalmologist have many other tricks.This is how they, in part, earn a helping make dry eyes feel fine etc.  Good luck

Lacrimal gland/duct injury with upper blepharoplasty/ptosis surgery?

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While theoretically possible, the position of the lacrimal gland beneath and lateral to the bony orbital roof (actually inside the orbital rim) makes injury to this area extremely unlikely. However, dry eye after upper blepharoplasty can occur simply because the eyelid is in a more open, alert, youthful position which can lead to more evaporative loss of the tear film. This is particularly worse as all of us age, as the tear film loses some of its lubricating properties and evaporates more easily. Add to this improved eyelid position that occurs as a result of ptosis repair and you have a quite plausible explanation for dry eye(s). Even without eye surgery of any kind, as we age this tends to become an issue for more individuals.

Fortunately, there is help in the form of artificial tears, and there are several kinds to choose from, including prescription medications that can enhance tear production and help you with this problem. Be aware that this can be chronic, and may be a less-than-ideal side effect of having better looking eyes. Ask your plastic surgeon's advice, and he/she should not be hesitant to refer you to an ophthalmologist or oculoplastic surgeon for more advice if you wish. Good luck!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Dry eye is a difficult situation

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Dry eye after blepharoplasty is not an uncommon problem, especially when a ptosis repair is performed at the same time, since now more of the eyeball is exposed. An injury to the lacrimal gland or the ducts of the gland is extraordinarily unlikely. The gland actually sits under the bony rim along the outside of the eye and the ducts go directly down on the eyeball, so an injury to the gland or ducts is almost impossible. I would recommend seeing an ophthalmologist so an appropriate diagnosis can be made regarding your dry eye symptoms.
Andrew C. Campbell, M.D.
Board Certified Facial Plastic Surgeon

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Injury to the ductules improbable.

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Ptosis surgery lifts and opens the upper eyelid.  While your eyes look brighter, the larger eye does experience increase evaporative loss that may contribute to dry eye.  Any motor nerve injury affecting the blink rate can also bear on the situation.  Seeking a second opinion from an oculoplastic surgeon is an excellent idea.  The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a directory on their website that can help you locate a well qualified surgeon in your area:

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Dry eye after lid surgery

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Dry eye is a possibility after ptosis repair but injury to the lacrimal gland/ductules would be unusual by an experienced surgeon.  I would recommend seeing an ophthalmologist or an oculoplastics surgeon to determine the etiology of your dry eye and to direct treatment so that you have relief of your symptoms.

Keshini Parbhu, MD
Orlando Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.