Tear production test before lower bleph?

How is this test preformed and is it very uncomfortable? My surgeon is requiring it for lower blepharoplasty- is this normal?

Doctor Answers 8

Test for dry eyes prior to blepharoplasty procedure

There is a tear production test that can be performed before upper or lower blepharoplasty which is performed usually an ophthalmologist office.  It is  called a Schirmer's test that involves placing a small paper strip in the eyelid measuring how fast it takes to absorb tears on that small strip of paper.  This  is a painless procedure.  Its best to know how dry the eyes really are before undergoing elective cosmetic surgery 

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Schirmer's Test

The Schirmer's or Tear Production test is a helpful piece of information before a blepharoplasty in a patient who either has a history or potential dry eye symptoms.  Some physical findings also put you at risk for this problem after eyelid surgery.  The test is very simple and painless. It involves putting a paper strip inside the lid and measuring how much tear fluid is produced over a period of time. Although not a perfect test, it is helpful to know if you are at risk for dry eyes before having eyelid surgery.  Best wishes!

Robert F. Centeno, MD, FACS
Columbus Plastic Surgeon
4.9 out of 5 stars 77 reviews

Tear Production and Blepharoplasty

One of the concerns with blepharoplasty is that is can make a dry eye drier. A schirmer test should be done for any patient who has a risk of dry eyes before lower eyelid surgery is performed. It is not uncomfortable and the fact that your surgeon is requesting it shows that he or she is doing a complete work up.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

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!

Katherine Zamecki, MD, FACS
Danbury Oculoplastic Surgeon

Tear production test

Hi there,  The test for tear production is called the Schirmer's test. Basically, a small strip of filter paper is placed in the lower eyelid to measure moisture. The whole test takes less than 5 minutes and if necessary numbing drops are placed in the eyes to make the test more comfortable. If you have a history of dry eyes, I think it is very smart to do the test before proceeding with eyelid surgery. Moisture and tears in the eyes protect the eye from getting too dry and developing a scratchy sensation in your eyes or even ulcers in the eyes.Hope this information helps! Good luckDr. Myriam Loyo 

Myriam Loyo, MD
Portland Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

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.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

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.

Byron A. Long, MD
Marietta Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Tear production test before lower bleph?

There are also a number of other tests that can be performed and your eye doctor might offer you an alternative to the Schirmer's test.

David A. Caplin, MD
Saint Louis Plastic Surgeon
5.0 out of 5 stars 33 reviews

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.