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Can Eye Lid Surgery Lead to Dry Eye Syndrome?

All surgeries have inherent risks. To minimize these risks and complications, one must choose a properly trained and experienced surgeon.

This axiom holds true even for eye lid surgery, or blepharosplasty. There is a misconception that patients who go through this procedure will eventually experience dry eye syndrome.  While there may indeed be cases attesting to such, a well-trained eye doctor will know how to minimize this complication.

A pre-surgery evaluation must be initially conducted to check for any lid margin disease that has to be dealt with before the operation. A test called the tear break up time is done to check if the tear film is stable. Any abnormalities will be treated first with medicines. This will heal the lid margin and stabilize the tear film, helping you get ready for the operation.

Will that totally erase the risk of contracting dry eye syndrome after blepharosplasty? As mentioned above, the risk is minimized, but dry eyes may still occur for the following reasons:

•    The glands that produce your tears are made up of the inner mucinous layer, the middle aqueous layer, and the outer oily layer. Immediately after your operation, swelling and inflammatory response may affect these glands. This will lead to tear film dysfunction, or TFD. As a result, you may experience blurry vision.

•    Old patients undergoing eye lid surgery are more likely to have tear film imbalance. Aging brings about more sensitivity to hot weather. Tear production also decreases with age, thus resulting to a feeling of dry eyes.

•    People with immunity disorders, like rheumatoid arthritis and thyroid problems, rosacea patients, and those taking antihistamines and antidepressants are more prone to have dry eye syndrome after eye lid surgery.

Minimizing Dry Eye Syndrome

So how do eye doctors minimize dry eye syndrome after a blepharosplasty procedure? Surgeons may use different techniques to decrease the chance of tear evaporation and corneal exposure:

•    Avoid overcorrection. Interference with blinking must also be kept at a minimum.

•    Avoid lower eyelid blepharoplasty.  Retraction of the eye lids is the most common negative reaction to this kind of surgery, so eye doctors avoid this procedure. Instead, a less invasive procedure used is transconjunctival lower blepharoplasty. This latter procedure does not carry the same risk of lower lid retraction.

•    For surgery in the upper eye lid, local anesthesia with sedation is utilized, instead of general and deep intravenous anesthesia. Using local anesthesia will mean a better feedback mechanism during the surgery. This means a lower chance of overcorrection done accidentally. Skin removal is also done in a conservative manner.

•    No muscle is cut, with the orbicularis being bored with a small hole to access the fat pockets, instead of creating a wide opening.  The result is the preservation of the blinking mechanism, with the chance of hollowing also decreased.

•    Surgery will lessen the force of blinking, so artificial teardrop is advised to prevent dry eyes. A lubricating ointment can also be applied before going to sleep.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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