Blepharoplasty is one of the most common plastic surgery operations. It may be done to treat excess skin on the upper eyelids (upper blepharoplasty) or to reduce the appearance of bags and dark circles under the eyes (lower blepharoplasty). The surgeon must remove skin in all upper blepharoplasties and most, though not all, lower blepharoplasties.
Excision of eyelid skin puts the patient at risk of developing dry eye symptoms after blepharoplasty. The main reason is that this operation interferes with the blink mechanism of the eye. The symptoms are especially common in patients who had dry eye before the operation. The severity of the symptoms will vary with some patients experiencing mild foreign body sensation, while others may see their quality of life severely affected and their vision impaired.
Treatment of dry eye after blepharoplasty will depend on its severity, the integrity of the cornea and whether too much skin was removed during the operation. Most patients will do well with preservative-free artificial tears applied in both eyes as needed. These may be kept at room temperature or they may be refrigerated and applied as cold drops. If artificial tears are not enough, ophthalmic gels and ointments may be recommended.
If the patient is unable to close his or her eyes after the operation, severe dry eye will inevitably ensue. This is a condition known as lagophthalmos. The cause is skin shortage from removal of too much skin during blepharoplasty. Lagophthalmos is a serious complication because it puts the patient’s cornea at risk and may significantly impair visual health. If this complication develops after upper blepharoplasty, the only good alternative may be to go back to the operating suite and place a skin graft. In patients who had lower blepharoplasty and develop lagophthalmos, a midface lift may correct the problem without the need for a graft.
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