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Dry Eye and Blepharoplasty (Eyelid Lift)

An eyelid lift, known more commonly as blepharoplasty, is a form of surgical procedure generally used to remove sagging skin, or to add or remove fat from around the eyelids. Although it’s frequently called an “eyelid lift”, blepharoplasty doesn’t actually involve any lifting of the eyelid. Upper blepharoplasty surgery uses incisions within the skin to allow for the removal of fat and skin, after which a thin stich brings the skin together to create a new eye crease. While blepharoplasty is a very common form of cosmetic surgery, it can be detrimental for people who already suffer from dry eye syndrome, and may lead to dry eye issues in some patients.

Candidates for Blepharoplasty

Blepharoplasty can be a great way for some people to improve their self-confidence and appearance – although it won’t necessarily produce the results that you consider to be “ideal”. Before you decide whether you should have surgery, it’s worth thinking about your expectations and reasons, and discussing them with your doctor.

The best candidates for blepharoplasty are generally women and men that are psychologically stable, physically healthy, and prepared with realistic expectations. While most people who undergo blepharoplasty are aged thirty-five and older, if you have an eyelid condition that runs in the family, you might choose to undergo surgery at an early age.

As with many surgical procedures, there are some medical conditions that can make blepharoplasty a riskier choice. These conditions include thyroid problems such as Graves’ disease and hypothyroidism. Another severely worrisome condition is dry eye syndrome, or the insufficient production of tears.

Dry Eye and Blepharoplasty

While going under the knife for any purpose may not be the most comfortable of affairs for anyone involved, a large fraction of modern society has become so nervous about the concept of natural aging that they would rather seek surgery than start to see wrinkles. Such an endeavor can lead people to seek out blepharoplasty, even when they have a condition that may make the procedure riskier. While studies have shown that some people suffering from mild cases of dry eye syndrome have been able to undergo blepharoplasty without any complications, most surgeons recommend that dry eye suffers should not consider blepharoplasty at all. The reason for this is that the risk of further complications to current dry eye problems is much too high. What’s more, there is no guarantee that existing dry eye symptoms will not be permanently worsened by the procedure.

Though blepharoplasty can help to remove the bags that gather underneath our eyes as we get older, it also regularly causes significant dry eye symptoms post-surgery. Because the procedure involves removing excess skin, fatty tissue, and muscle, the process can sometimes weaken the eyelid function, reducing the blinking ability. When the ability to blink is altered, then it can be difficult for individuals to efficiently move tears and blink as they should, and this issue can lead to dry eye syndrome and other painful issues.

All Surgeries Carry Some Risk

When eyelid surgery is effectively conducted by a plastic surgeon, complications are generally minor and quite infrequent, even in people who already have dry eye syndrome. However, as with any surgical procedure, there is always a possibility that complications may arise, including a reaction to anesthesia, or potential infections. The best thing you can do to reduce your risks of suffering from dry eye symptoms following surgery, or any other complications, is to follow the instructions your surgeon gives you as carefully as possible.

Some of the minor complications that can follow blepharoplasty surgery may include:

  • Blurred or double vision
  • Temporary swelling around the eyelids
  • Dry or gritty eyes
  • Asymmetry in scarring or healing
  • The appearance of tiny whiteheads that can be removed with a fine needle
  • Trouble blinking or fully closing the eyes for sleep
  • Ectropion – a pulling sensation on the lower lids

Many patients find that the most common condition to occur following surgery is dry eye syndrome. Persistent dry eye can sometimes be a significant problem, and may even emerge as a result of a pre-existing complication or surgical problem. Some factors that can make the development of dry eyes more likely following an eyelid lift include:

  • Bulging eyelids
  • Prior dry eye history
  • Thyroid problems
  • Autoimmune disease
  • Tear duct defects
  • The removal of too much skin during surgery
  • Significant swelling

When it is possible to identify these factors in advance, measures can be taken to reduce or avoid the risk of permanent dry eye symptoms. Depending on the nature of the problem in question, a conservative eyelid lift that involves less skin removal may be necessary. In some patients, special lid tightening procedures can help to improve the results of eyelid surgery, while avoiding dry eye problems. In some cases, when the risk of developing dry eyes is particularly high, some surgeons may recommend the complete avoidance of blepharoplasty.

Serious Complications

If the lower eyelid is affected by too much skin removal during blepharoplasty and the resulting problem is an inability to close the eye, there may be severe results. If the cornea and eye cannot be properly covered, moistened and protected by the lids, this can lead to corneal problems and severe irritation. As a result, the symptoms of dry eye that occur can be significant, and lead to keratitis.

Keratitis is the medical term used to refer to inflammation that takes place within the cornea, the dome shaped window at the front of the eye. Signs and symptoms of keratitis that may occur after blepharoplasty surgery include:

  • Severe pain
  • Constant tearing
  • Blurry Vision
  • Redness
  • Sensitivity to Light

Treatment for Dry Eye Following Blepharoplasty

Many problems associated with dry eye syndrome and blepharoplasty can actually resolve themselves over time, and surgical treatment is generally only recommended after a problem has lasted for longer than three months. In order to help prevent keratitis and corneal damage in the meantime, doctors will prescribe gels and ointments.

The treatment of the symptoms of dry eye syndrome that occur quickly after a blepharoplasty procedure are often quite simple. Doctors typically recommend the use of prescription eye drops and saline solutions alongside lubricating ointments that can assist in keeping the eyes moist. However, if the dry eye condition persists for longer than a few weeks, despite the assistance of topical treatments, it’s worth seeking out additional help from a doctor which should assist in identifying and treating the cause accordingly.

While it is often possible to prevent significant problems that can occur as a result of blepharoplasty, it is important to note that permanent dry eye syndrome following surgery can be a risk. Often, your surgeon will discuss this with you in advance, as being aware of all the risks of surgery is an integral part of being an informed patient. Consideration of surgery should only be allowed when the risks are as minimal as possible.

Resources and References:

Eyelid Surgery (Blepharoplasty) – Information about eyelid surgery and how to prepare for blepharoplasty. (MedicineNet.com)

Complications of Blepharoplasty: Prevention and Management – General information about blepharoplasty and details of complications that may occur. (Plastic Surgery International)

Safety of blepharoplasty in patients with preoperative dry eyes – Safety guidelines for blepharoplasty in patients with dry eyes. (NIH.gov)

Management of Cosmetic Eyelid Surgery Complications – Study regarding the management of complications of cosmetic eyelid surgery. (NIH.gov)