My Eyeballs Feel "Cold" and Irritated All the Time 5 Months After Lower Bleph.

Question

I had transcutaneous lower bleph 5 months age, with a very long recovery! My lower lids are now slightly lower than prior to surgery. I am 49yo, healthy, this is my first plastic surgery and probably my last! My eyeballs feel like I have menthol in them...no tearing, slightly lrritated,but just feel really weird and uncomfortable. Will this go away?

Mehryar (Ray) Taban, MD, FACS · Answer

Without looking at your photo, it is likely you are talking about lower eyelid retraction/ectropion, with inability to fully close your eyes or blink. It may get better. You should see an oculoplastic surgeon for evaluation and possible treatment. In the meantime, lubricate your eyes.

Kenneth D. Steinsapir, MD · Answer

Unfortunately, transcutaneous lower blepharoplasty is notorious for damaging the muscle fibers of the lower eyelid right at the lid margin. These fibers are the very most important for helping move tears on the surface of the eye. In the general plastic surgery literature there are very influential papers suggesting that it is OK to do this type of eyelid surgery because the motor nerves come in from the side of the eyelid. There is actually very little to support this and very good papers that suggest the the nerves come from below to supply the lid margin muscle. This of course is consistent to what we see. Your general plastic surgeon does not own or understand how to use the equipment to assess you for dry eye. It is possible that time will help you but honestly, 5 months is a long time. You might need reconstructive eyelid surgery. However, I strongly recommend finding a cornea specialist in your community to like to provide patient care. This individual can help manage your dry eye.

Peter E. Johnson, MD · Answer

A dry eye can have many causes after a lower lid blepharoplasty. In order to fully assess the situation and cause of the dryness that you are now experiencing, we would recommend that you see your plastic surgeon for for an eye examination, and a schirmer's test to make sure you have an adequate tear film.

Travis L. Shaw, MD · Answer

Dear vanurse: I agree with the other physicians that you may have one of the dreaded complications of eyelid surgery known as ectropion. There are conservative measures such as massage and drops, but at 5 months the situation may have settled in. If it has come to the point where you are really bothered by your eyes, I would recommend visiting a board certified facial or oculoplastic specialist to discuss your options. As a facial plastic surgeon, I have performed surgeries as a team with an oculoplastic surgeon, using fat grafting from the abdomen to rebuild the support structure under the cheekbone and eye socket to help support the lower lid while maintaing the cosmetic benefits of the blepharoplasty. Best wishes, Dr S.

Alexis Verpaele, MD · Answer

Dear,

	it would help a lot to see some before/after pictures to better analyse the situation. But from your story I would guess that you probably have some "ectropion", which is the condition where the lower eyelid has descended a bit and doesn't sit snugly against the eyeball anymore.

	Massaging the eyelid upwards against the eyeball can help, but usually after 5 months the situation has already stabilized. If massageing does not help, a correction may be necessary to reposition your eyelid. This correction is called a canthopexy, and should be part of any plastic surgeon's armamentarium.

My Eyeballs Feel "Cold" and Irritated All the Time 5 Months After Lower Bleph.

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