• Can a Dry Eye Patient Get Eyelid Surgery?

    by Ann Jayaram, MD
    on Jan 11th, 2017

The answer is yes. There are some additional things that you need to consider. But it does not necessarily preclude you from moving forward.  Upper lid blepharoplasty is one of the most rewarding satisfaction producing surgeries that one can udergo—A relatively straight-forward, often times in-office procedure can take years off of the appearance of your face—so understandably, everyone, including those with dry eye are interested in learning more about it. What things should you be cautious about if you have dry eye?

Lifting  your eyelids does just that. It lifts them.

Dry eye is a condition that can range from being asymptomatic to being absolutely downright debilitating. It is caused by one of two overarching problems: insufficient tear production or overexposure of the eye….or in some cases, both.  Upper lid blepharoplasty removes redundant eyelid skin on the upper eyelid, giving a more youthful appearance, but also raising the place where the upper eyelid meets the eye—causing more of the cornea-the anterior clear structure of the eye—to be exposed all day long. As you can imagine, the more of the cornea exposed to the air, the more your existing tears can evaporate.  Another factor to consider is what happens when we close our eyelids? If too much skin is removed from the upper eyelids, they may not be able to close all the way—causing major dry eye complications on the inferior portion of the eye. This becomes especially problematic when we sleep—often if one has too much skin removed from their upper eyelids, the will have about 1-2 mm of lower eye exposure during sleep. This is a dry eye nightmare!

Ok so lift my lids….but just don’t lift them too much.

Well that is definitely the idea—but it doesn’t always happen.  Plastic surgeons have many different ways of determining how much skin to remove during upper lid blepharoplasty. A general rule of thumb is that there should be about 20 mm of skin remaining from upper eyelid margin to lower eyebrow.  While this is a nice rule, most of the time, surgeons use a pinch test to determine the appropriate amount of skin to excise. This involves setting the lower portion of the skin incision at the natural eyelid crease and using a set of forceps to pinch an acceptable amount of skin to excise while making sure the eyelid can still close and doesn’t lift too much. However, often times, surgeons just focus on how much skin should be removed to produce a tight, wrinkle-free upper eyelid—and this can often lead to overlifting. 

Things to think about if you have dry eye and are considering eyelid surgery:

References

Naik, Milind N et al. “Blepharoplasty: An Overview.” Journal of Cutaneous and Aesthetic Surgery 2.1 (2009): 6–11. PMC. Web. 4 Jan. 2017.

Saadat D et al. “Safety of blepharoplasty in patients with preoperative dry eyes.” Arch Facial Plast Surg. 2004 Mar-Apr;6(2): 101-4.


Author Ann Jayaram, MD Ann Jayaram, MD is a a Bay Area Oculoplastic Surgeon specializing in upper and lower lid blepharoplasty, botox, and filler injectables. She is also a board certified ophthalmologist. She practices in Menlo Park, CA, and in her spare time enjoys good views and great wine.

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