Upper Blepharoplasty Despite Severe Dry Eyes?

Question

I'm a 32 year-old male suffering from severe dry eyes, but I want to get upper Blepharoplasty done to correct very droopy lids. Is there any way this could be done, if approached carefully enough, to ensure completely that my dry eye problem will not worsen after the procedure (of course, accepting that for the first weeks it will be worse inevitably)? Any answer would be greatly appreciated.

Brent Moelleken, MD · Answer

Patients should be carefully evaluated for the cause of their dry eye syndrome.
Often this is done inconjunction with an opthalmologist and a plastic surgeon, particularly one who specializes in surgery of the face and midface.
If postsurgical changes from a lower eyelid surgery are to blame for a dry eye syndrome, there may be help available from a cheeklift procedure with or without canthal reconstruction.  Plastic surgeons who specialize in the midface are particularly familiar with this area, and are capable of reconstructing eyelid defects from small to enormous, including entire eyelids, midfaces, microvascular reconstructions, etc.  
A plastic surgeon with an artistic eye will also be able to guide you in evaluating facial proportion as a whole, including the cheeks, the eye-cheek junction, brow position, brow aesthetics and should have familarity with the many types of cheek and brow elevation procedures available.  Our chapter in Mathes Plastic Surgery on the midface and brow may be helpful with some of these issues (referenced below).
There is no question that the presence of dry eye syndrome should play a role in the decision making preoperatively, but most dry eye patients are still able to have upper eyelid surgery.

Kenneth D. Steinsapir, MD · Answer

Dear Christopher
Dry eye syndrome is very common.  It is not a reason to avoid eyelid surgery unless there is an exceptional circumstance.  Among eyelid surgeons, only fellowship trained eye plastic surgeons are prepared to manage a dry eye and design eyelid surgery for you that is appropriate for your degree of dry eye.  Dry eye needs to be actively managed and supported following eyelid surgery.  If surgery is properly done, then once the eyes are healed eye comfort should return to its per-operative state.  This might take 6 to 8 weeks.  
Commonly after aggressive eyelid surgery, the muscle that closes the eye can be damaged or too much skin can be removed making it difficult to close the eyelids.  However, these type of complications are associated with aggressive blepharoplasty.  Until you have been assessed by a surgeon, you do not know exactly what you need.  You may have a heavy upper eyelid fold that would benefit from upper blepharoplasty or a forehead lift, or you might have an actual fall in the eyelid margin, which is called upper eyelid ptosis.  Upper eyelid ptosis requires a different type of surgery where the tendon of the muscle that raises the upper eyelid is shortened.
It is worth your while to seek out a fellowship trained eye plastic surgeon who is also board certified in ophthalmology.  ASORPS.org maintains a website with a referral resource by location to help you find eye plastic surgeons in your area.  This type of surgeon will be able to diagnose your droop eyelid problem and manage your dry eye without having to see a lot of different specialists.

Edward Buckingham, MD · Answer

As mentioned in the previous answers it is difficult to tell whether you are to undergo a blepharoplasty or a ptosis repair. If your description of "droopy eyes" is that you have redundant skin then a blepharoplasty will help. If you have low eyelid margins ie. the whole lid is droopy then you are likely to need a ptosis repair. Both can be done with dry eyes, but caution is the rule. Be evaluated by an ophthalmologist before surgery and make sure that your surgeon is aware of the condition and will be conservative. Expect to need more lubricating drops in the initial post operative period. If done with care the procedure can be successful however.

Richard D. Gentile, MD · Answer

It is common for plastic surgeons to ask about dry eyes when contemplating doing upper blepharoplasty surgery on patients. I do agree that it is a relative contraindication and you need to balance your desire to have the surgery with the knowledge that it may make your condition worse. A quantification of the degree of the problem should be reviewed with a Schirmers test as well as the opinion of your opthalmologist regarding having the surgery done.

Christopher L. Hess, MD · Answer

Dry eyes is a common problem mostly in women in their late 40's and 50's.  Blepharoplasty,particularly lower, can worsen the problem, especially if the have a negative vector.  Upper lid bleph holds less risk as long as no lacrimal gland manipulation is done.
So no 100% guarantee but it can be done without worsening your condition.

Scott E. Kasden, MD, FACS · Answer

It can be safely done, however, no one can completely assure that your dry eyes won't be exacerbated.  You may want to go to an opthomologist and discuss putting in silicone plugs into the tear ducts to maximize your tears at the same time.  The dry eyes are more of a problem with the lower lids, and so do not get them both done at the same time.
sek

John Pak, MD, PhD · Answer

If your physician recommends a blepharoplasty and not a ptosis repair, your dry eyes should not be affected as long as you are able to close your eyelids after the surgery. 
However, you mentioned that you have "droopy" eyelids, which suggests that you might be undergoing a ptosis repair.

Francis (Frank) William Rieger, MD (retired) · Answer

It would be wrong to try to correct  upper eyelid  looseness with a history of dry eyes.  This could only further increase the tendencies for eye corneal irritation and ulcerations.  A proper evaluation by a Plastic Surgeon or Opthalmologist could give you some guidance  about this.

	 

	Good luck.

	 

	Frank Rieger M.D.

Francis R. Palmer, III, MD (retired) · Answer

I have performed Blepharoplasty for over 20 years and severe dry eye symptoms would be an absolute contra-indication for Upper Eyelid Blepharoplasty IMO. You might consider having the severe dry eye treated first using tear duct plugs at an Opthalmologist for resolution of some of the symptoms before having Blepharoplasty.

Harrison C. Putman III, MD (retired) · Answer

If you are going to have this procedure you must consult with your opthalmologist to determine the actual severity of the problem and whether anything else might be done to improve the condition, in my opinion. Punctal plugs, Restasis, Omega 3s, and other measures are often helpful for dry eye problems. Very conservative upper blepharoplasty can often be performed, but it may be prudent not to have muscle excised, as this will slow the blink reflex for awhile and will likely aggravate the dry eye symptoms, at least temporarily. Likewise, skin excision should be more conservative than usual, and your surgeon should save the skin in sterile saline afterwards for at least 6 weeks; it can be replaced if lagopthalmos or dry eye symptoms mandate. Good luck

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