Tear production test before lower bleph?
Doctor Answers 8
Test for dry eyes prior to blepharoplasty procedure
Tear Production and Blepharoplasty
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Tear production test
A tear production test, called a Schimer's, measures your tear production over a period of time (several minutes). The test is performed by placing a small strip of paper in each lower eyelid pocket, having the patient close his/her eyes, and measuring the tear production after a specific period of time. Often the test is performed after topical anesthetic drops have been instilled in the eyes. The test is not invasive, not uncomfortable and is part of a work-up for dry eyes. Many oculoplastic surgeons will perform this test prior to eyelid surgery. Good luck!
Tear production test
Your surgeon is being thoughtful by requiring the test to anticipate dry eyes. The surgery can still be done even with dry eyes
Thank you for your question. You ask about the tear production test as your surgeon is insisting you get this test for tear production before you have lower eyelid blepharoplasty, and ask about how comfortable it is.
I can give you some perspective on this concern your doctor has. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and this concern about dry eye after lower eyelid surgery is something you actually appreciate your doctor being concerned about, which I will explain further
One of the most deceptively complicated surgeries is lower eyelid blepharoplasty. The lower eyelid is very important in the function of tear distribution over the eyeball, the eye itself, and the cornea. Unfortunately, often after lower eyelid surgery, people will have some degree of eyelid retraction as well as dry eye problems. As an oculofacial cosmetic surgeon with this as an area of focus and specialty, I treat people from all over the world with lower eyelid retraction, ectropion, incomplete eye closure, and problems with dry eyes. Dry eyes is a very challenging issue to deal with. This isn’t meant to scare you off from having this surgery, but very thoughtful plastic surgeons are aware to at least have an ophthalmic exam for their patients before the procedure. They want to know if you already have dry eyes so it will hopefully guide them on how they do the surgery.
An ophthalmologic examination is not just a single test, but the test they’re describing is the Schirmer's test. Schirmer's test has been around forever in ophthalmology. As an oculofacial plastic surgeon, I first did my residency in ophthalmology before plastic surgery of the eyes and face. Schirmer’s test is a little strip of paper placed just at the eyelid to measure how much tears are produced. It is not a perfect test because if you have the slightest bit of discomfort with the placement, your eye produces a lot more reflexive tears, so the paper gets more soaked and it looks like you have more baseline tears than you actually do. Also, the ophthalmologist looks at the tear film, your baseline tears, and the health of your eyes with a slit lamp
I advise you to follow your doctor’s recommendation and have your eyes checked for dry eye, but that doesn’t mean people with dry eye can’t have eyelid surgery. As a specialist, people who have severe dry eye, Sjogren’s syndrome, rheumatoid arthritis, and many different issues have come to me because of my knowledge of how to manage their dry eyes. Oculoplastic surgery is eyelids, orbit and lacrimal system, so we know a lot about the tear production and the tear drainage system.
It is also important if you do have dry eye to manage them using artificial drops for lubrication to just keep the eyes moist. I generally recommend for people with a history of dry eye to be more vigorous about treating them before the surgery, so in case during surgery there is prolonged exposure of the eyes, they have a little moisturization ready. Afterwards, it is important to adhere to the dry eye treatment schedule. I highly recommend you move forward with the dry eye evaluation, and discuss with your doctor what the overall game plan would be once the evaluation is completed. I hope that was helpful, I wish you the best of luck, and thank you for your question.
Dry eye test before lower eyelid surgery
There are several tests for dry eyes available. The newer ones are more accurate and there is no discomfort.
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