Eyelid surgery, chemosis, dry eyes, blepharitis. Can I use regular lubricating eyedrops or do they need to be preservative free?

Temporary dry eye symptoms are a given for almost all patients after upper or lower eyelid surgery.Usually the symptoms are very mild and easily managed.  I recommend that all of my patients use artificial tears drops frequently during the day for at least 4-5 days no matter what then on an as needed basis after that.  Most patients will benefit from using a lubricating ointment like Refresh PM at night for at least the first few nights.You do need to think about using preservative free drops / ointment in patients who may be having some added irritation from the drops themselves. Another good option to keep in mind is to add an antihistamine eye drop.  Good over the counter options are Alaway or Naphcon-A (but Naphcon also has an ingredient that helps to remove redness).  The advice above is good to consider for most cases of mild irritation that persists after blepharoplasty, but if there is any question there should be a low threshold to have the patient evaluated by an Ophthalmologist.

I would recommend an opthalmic ointment in order to keep the eyelid mucosa well lubricated.  Also an ointment with steroid like hydrocortisone to help limit the inflammatory response.  Talk with your surgeon for a prescription.  

Some people will develop a dry eye after surgery.  Chemosis is also not uncommon.  The chemosis may make the symptoms worse and you will feel like there is sand in the eye.  Lubricant drops help with all of this and help to speed up the resolution of the chemosis.  Some people are sensitive to the preservatives in the drops, so if you already have an irritated eye, good idea to use the preservative free.  If you are using the preservative free you can use as often as you like such as every hour.

  I advise my patients that ANY eyelid procedure is a drying experience (that it may worsen dry eye syndrome).  of course, you are welcome to use ANY type of lubricating eye drops.  However, I have also found that in severe cases, PF (preservative free) eye drops, even a store brand, may give better relief for some patients  than any drop containing preservatives.  The good news is that after 6 months or so, these symptoms usually abate.  Good luck!

When you need to use eye drops frequently, the absence of the perservative makes a difference because many people actually get irritation from exposure to the preservative.  For this reason, for individuals who need to use artificial tears frequently, the preservative free products seem to be a very good idea.  With regard the the frequency, it is essential to understand that the drop only sticks around 30-40 minutes and then it is gone.  Whenever help it was doing is also gone.  For this reason, if you are having a bad day, you might find it beneficial to use the drop every hour during the day.  If you are going to bed and the eyes are bothering you, consider using a bland ophthalmic ointment like Refresh PM at bedtime.  You only need a few mm of ointment.  Instill it by pulling the lower eyelid down.  It will melt and coat the eye so you don't need to do this which can risk scratching the cornea.  If you find yourself frequently having bad days, it can be very helpful to also see a cornea specialist.  They can work with you no the use of antibiotics to improve the blepharitis, plugs to help trap moisture and other measures that can help eye comfort.