What is the Best Eyelid Surgery Technique to Avoid Occurrence of Dry Eyes?

Does the dryness only occur after eyelid surgery because of eye shape changes? Is it possible to manage this side effect using special eye drops?

Doctor Answers 9

If you are normal before surgery, careful design of the eyelid surgery will leave you enough skin to easily close your eyes.

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The greatest risk of dry eyes post surgery is taking too much skin out so that the eyelids cannot easily close at night.  A skilled and experience eyelid surgeon can minimize the risk of dry eyes after blepharoplasty.  Seek a consultation with an experience and well respected eyelid surgeon in your area.

Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Dry eye after blepharoplasty

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There are alot of potential reasons for patients to get dry eye after eye surgery. First they may be prone to it, second the surgery may disrupt the natural drainage and tear production, ectropion or sclera show with wekaness of the the lower lid may cause this as well.  Lubrication after surgery, evaluation before surgery, and canthopexy/canthoplasty may help diminish the risk of it.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Dry eye after cosmetic eyelid surgery?

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No, post-surgical xerophthalmia (dry eye) is related to many more complex factors than changes in shape of the palpebral aperture. Dry eye is managed chiefly by prevention, and when this fails, as it frequently does, by a variety of measures depending upon the clinical situation. "Eye drops" to add moisture is certainly the most basic and first line treatment.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Eyelid surgery and dry eyes

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If I see a patient who already has dry eyes and wants a blepharoplasty, I will recommend a transconjunctival approach to the lower lid, meaning that the incision is on the inside of the eyelid.  That way you are highly unlikely to experience ectropion, or downward bowing of the eyelid, which if it happens can contribute to problems with the tearing mechanism.  For the upper lids I would be conservative in how much skin is removed. Remove too much and the patient won't have complete closure and will experience dry eyes.  If you are asking which operation to do to avoid dry eye syndrome post-op, again conservatism is the key.  What is done to the lower lid will depend on what the abnormality is to begin with. Most of the time something will need to be done to support the lid. Many times patients will need temporary help with dryness with drops or ointment for a period of time post-op. This should not lead to permanent dryness unless one of the aforementioned problems exists.

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon
4.8 out of 5 stars 32 reviews

Dry eyes after blepharoplasty

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Your question is not appropriately formatted because the best procedure or technique in one patient can cause a major problem in another. There are lots of different reasons why someone could have dry eye after blepharoplasty including they had it marginally before surgery and then have it fully afterward. It can be from taking out too much skin or it can be from failing to tighten the lid horizontally/vertically with a canthopexy. Your surgeon needs to examine you fully before surgery and then tailor the surgery to minimize the risks of these problems occuring afterward. Sure you can treat it with drops especially if it is only a temporary problem after surgery. Everyone however wants to prevent it from being a permanent problem after surgery.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

What is the Best Eyelid Surgery Technique to Avoid Occurrence of Dry Eyes?

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 Dry eye syndrome is the result of increased exposure, of the eyes, after Eyelid Surgery.  This occurs when too much skin has been removed from the upper eyelid and/or the lower eyelid drops in position.  Find an experienced plastic and cosmetic surgeon to perform the eyellid surgery and have the lower through a transconjunctival approach.  This approach has much less incidence of lower lid malposition which was the conclusion that i published in a scientific paper on the subject back in the early 1990's.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

I would take exception to Dr. Truong's statement, with all due respect.

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Many, many people having eyelid surgery in fact already have dry eye.  The swelling of the eyelids makes this dry eye much more symptomatic.  Within a few weeks much of this swelling resolves with improvement in the dry eye symptoms.  Artificial tears and ointment can be beneficial for ocular comfort while the swelling persists.

Dr. Truong states "Long term dry eyes following eyelid surgery is usually due to a technical error on the part of the surgeon such as too much skin is removed from the upper or lower lids or using the wrong approach to the lower lids causing scarring and lid retraction."  This can be the case.  However, in many cases, the surgeon has not made a "technical error."  Standard eyelid procedures practiced in routine fashion by thousands of surgeons will cause damage to the orbicularis oculi muscles.  Specifically, the lower eyelid infracillary skin muscle incision for performing lower eyelid surgery has the potential to injure the muscle that helps blink the eyelids closed.  Therefore a motor injury from this standard surgery is not the result of an "error."  Rather it is an expected adverse event that will necessarily be seen in a certain percentage of patients undergoing this type of procedure.  Midface surgery performed through a lower eyelid incision also has the same potential for damaging this muscle.  Why do surgeons still perform these types of surgeries then?  It is because well respected leaders in the field wrongly promote these procedures.  These injuries and the dry eye that is caused is not from a technical error but  rather is a foreseeable consequence of particular surgical approaches.  

So while I take exception to the characterization that these issues are due to errors, I also think that Dr. Truong is correct in saying that who you choose as your potential surgeon makes all the difference.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Dry eyes and eyelid surgery

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Short term dry eyes is common with eyelid surgery due to swelling and alteration in the normal blinking mechanism. This is managed with artificial tears and other ocular lubricants. Long term dry eyes following eyelid surgery is usually due to a technical error on the part of the surgeon such as too much skin is removed from the upper or lower lids or using the wrong approach to the lower lids causing scarring and lid retraction. Some bridges should not be crossed so choose your surgeon carefully.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 42 reviews

Upper eyelid surgery and Dry Eyes

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The upper eyelid is the eyelid that blinks and distributes tears over the cornea.  There are two main reasons for dry eyes: reduced tear formation and inadequate movement of the upper lid.  As we age we tend to produce less tears and this can lead to dry eye symptoms like itching.  There are a number of eyedrops which help with this problem.  An upper blepharoplasty can interfere with movement of the upper lid temporarily after surgery or permanently if too much skin is removed.  

The key to dealing with the surgical issues is to have a conservative upper blepharoplasty especially if you have dry eye symptoms before the procedure or to not have the procedure at all.  Early after surgery some patients are symptomatic and eye drops work well.  You should be sure to tell your doctor if you use eyedrops or if you feel that you have dry eyes.  In plastic surgery in general and with eyelid surgery in particular conservative treatment is best.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 69 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.