Can I Have Upper and Lower Eyelid Surgery if I Have Dry Eyes?

My tear test was 4mm. I have some puffiness in the lower lids and some excess skin in the upper lids. I take antihistamines (Benadryl) regularly, could this cause my dry eyes? If I stop taking Benadryl would my eyes become less dry? I use antihistamine eye drops daily but I don't use drops for dry eyes. Under what circumstances could I have upper and lower eyelid surgery? What questions should I ask a plastic surgeon about my eyes? Does season matter (no winter surgery?)

Doctor Answers 11

Surgery is possible...but exacerbation of dry eyes is also possible

Conservative eyelid surgery [upper and lower] with proper technique is possible. The degree of underlying dry eye is a main factor. An exam by your Oculoplastics surgeon can assess the severity of the  problem and better assess the risk of surgery, and they may even have you seek help from a cornea surgeon to optimize your dry eye therapy before considering surgery.


Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Dry eyes and eyelid surgery

Yes you can have surgery but one needs to be careful not ot take out too much upperlid skin and cause you to not be able to close your eyes.Also with regard to the lower lids maybe just taking out the fat might be the right way to go again because if too much skin is removed then your lower lid casn droop and exacerbate your dry eyes.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 64 reviews

Dry Eyes and Blepharoplasty

While preoperative testing and evaluations are extremely helpful at gauging the risk of dry eyes after eyelid surgery, they are not always 100% accurate. Dry eyes are always a potential risk after blepharoplasty surgery and anyone that has that history before, regardless of the reason, has a very legitimate concern. In the face of dry eye history, blepharoplasty should be very conservative with minimal to no skin excision. This means a transconjunctival technique on the lower eyelids and minimal skin excision on the upper eyelids.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Dry eyes

Dry eyes are always a concern. First, you should get a thorough exam and then possibly consider staging the uppers and lowers seperately and performing very conservative procedures.  But I would consult with your ophthalmologist first.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Having been around the block....

The schirmers measurement of 4 mm is only part of the dry eye assessment.  It is not the last word on the subject.  I have been in practice long enough to have seen patients whose dry eye was made worse by even conservative transconjunctival lower blepharoplasty.  There is no substitute for a careful examination and surgery from someone who understands how to take care of eye comfort after surgery.  The idea that a general ophthalmologist can "clear" someone for surgery is generally an over simplification.  Very often the general ophthalmologist does not really understand the eyelid surgery and how it might compromise the eyelid function and ocular comfort.  If you are not sure, I would recommend assessment by a cornea specialist and optimization of your allergies to minimize the use of potential drying agents.


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

Can I Have Upper and Lower Eyelid Surgery if I Have Dry Eyes?

 You can have upper and or lower eyelid surgery with a history of dry eye but IMHO, the dry eye will certainly be worse and not better after the eyelid surgery.  If your general eye doctor clears you for the eyelid surgery, I would only consider performing either upper or lower eyelid surgery separately but not both together.  

  IMO, the lower eyelid surgery if done as a transconjunctival approach, should cause the least amount of further eye dryness.  You might consider treating the dry eye (if you haven't already) with drops and or tear duct plugs before and or after the eyelid surgery.  Hope this helps.  FYI, reason to avoid further eye dryness is the resultant eye irritation, infection and corneal ulceration formation.  So it's  a rather serious issue.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Dry eyes and eyelid surgery

First of all a lower lid blepharoplasty done through a transconjunctival approach will NOT exacerbate dry eyes. So the question is whether the upper bleph will exacerbate dry eyes. The answer is that it depends on a number of things. The best possible situation is if the excess skin is minimal and only a small amount of skin removal is required. The risk is minute there. The risk is higher if the hooding is excessive and a large amount of skin needs to be removed. The risk is highest if too much skin is removed such that the lids will not close completely. There are other factors such as poor tear breakup time, partial blinking, treatment of dry eyes with punctal plugs and/or Restasis. 

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 38 reviews

Your dry eyes may worsen after upper and lower blepharoplasty.

I read your concerns. Your eyelids function is to lubricate your eyes. Sometimes the lubricating function of your eyelids may become compromised after eyelid surgery. You should bring this concern to the attention of your surgeon. If your ophthalmologist confirmed your condition, you could ask if you're at high risk for experiencing an exacerbation of dry-eye. Or you could consider consulting an oculoplastic surgeon for an opinion.

Hope this helps.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 reviews

Eyelid surgery with dry eyes

Dry eyes is an important consideration with lid surgery as dry eye is a recognized complication or side effect. The antihistamine eye drops can cause dryness with regular use, though to know what your eye is up to, a full examination to assess tear film breakup, and tear production will help gauge what the risk for dryness and irritation might be.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

Dry Eyes

Thank you for the question. Benadryl is known to cause dryness of the eyes. Aging alone is associated with decreased tear production and dry eye symptoms and lower eyelid blepharoplasty is associated with increasing these symptoms. BUT, if done conservatively by a board certified plastic surgeon or oculoplastic surgeon, your risks can be minimized. A full evaluation is necessary to make a decision.

Jacob Freiman, MD, FACS
Miami Plastic Surgeon
4.4 out of 5 stars 272 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.