If lacrimal glands/ductules are injured during ptosis surgery and upper eyelid blepharoplasty, will it heal on its own?

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!

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
 

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: ASOPRS.org.