Published date: March 3, 2019; Accepted on: December 7, 2019; Collection date: 2020.
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The occurrence of dry eye disease resulting from ophthalmic surgical procedures is multifaceted. This study delves into the frequency, clinical signs, underlying mechanisms, and preventive measures of dry eye disease associated with cosmetic blepharoplasty. Emphasis is placed on minimizing postoperative dry eye complications and the judicious selection of surgical techniques and medications in the perioperative period.
Keywords: dry eye disease, cosmetic blepharoplasty, prevention
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In addition to cautious clinical strategies, there are several pre-existing risk factors that should be taken into consideration before undergoing cosmetic blepharoplasty. Patients with a history of dry eye disease, contact lens wearers, and individuals with autoimmune diseases such as Sjogren’s syndrome are at a higher risk of developing dry eye symptoms post-surgery. It is important for surgeons to assess and address these risk factors prior to the procedure to minimize the chances of post-operative complications.
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The performance of cosmetic blepharoplasty can either trigger or exacerbate dry eye disease, with postoperative incidence ranging from 0 to 26.5%. Clinical manifestations mimic general dry eye symptoms, while examination results fluctuate, underscoring the transient nature of postoperative dry eye complications.
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Various risk factors contribute to the development of dry eye disease following cosmetic blepharoplasty, encompassing anatomical, environmental, systemic, and pharmacological elements.
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| Structural | Ecological | Organic | Pharmaceuticals |
| Changes in eyelid structure | Exposure to air pollutants | Systemic conditions affecting tear production | Use of medications that can cause dry eye |
MECHANISMS
Typical tear production involves generating tears, blinking, and spreading them across the eye. Changes after cosmetic eyelid surgery can impact tear distribution and lubrication, leading to dry eye disease.
In addition to surgical procedures, factors such as aging, certain medications, environmental factors, and underlying health conditions can also contribute to dry eye syndrome. It is important for individuals who have undergone eyelid surgery to be aware of these potential risks and to regularly consult with their healthcare provider to monitor their eye health.
PREVENTION MEASURES
Preventing dry eye disease post cosmetic eyelid surgery is crucial and requires the surgeon to take preoperative, intraoperative, and postoperative measures.
Preoperative Evaluation
Patient Examination
Prior to the procedure, a thorough patient history is essential to identify dry eye disease or related risks. Assessing aggravating factors can assist in predicting the occurrence of postoperative dry eye disease.
Physical Assessment
Before the surgery, a physical examination is recommended to identify anatomical risk factors in patients. The Schirmer test can be used preoperatively to stimulate tear production. Local anesthetics are suggested to reduce tear secretion caused by corneal or retinal irritation.
Surgical Technique
Several aspects need attention during cosmetic eyelid surgery. Protecting the cornea during the operation is crucial to avoid potential damage. Trauma or prolonged exposure may lead to corneal irritation or ulcers, a primary cause of postoperative dry eyes.
When performing upper eyelid surgery, precise measurements of skin length are important, leaving 8-9 mm in the preseptal region and a minimum of 20 mm of upper eyelid skin. It is also essential to avoid lagophthalmos postoperatively, typically less than 2 mm, even in the presence of swelling.
Choosing the surgical approach consciously is vital. The frequency of dry eye disease after blepharoplasty with a skin and muscle flap (29.0%) is higher compared to transconjunctival access (25.6%) and transconjunctival access with skin clamp (22.9%).
Protecting the muscles and innervation surrounding the eye is crucial as their injury can decrease blinking frequency, leading to tear evaporation. However, for creating a natural upper eyelid fold in Asian eyelids, reducing the circumference by 1-2 mm along the incision is necessary.
Controlling inflammation by minimizing trauma can prevent chemosis. Fluid accumulation in the eyelid and subconjunctival space postoperatively due to disrupted lymphatic and venous drainage caused by scarring can contribute to chemosis.
The focus of postoperative dry eye prevention is on minimizing swelling, moisturizing, lubrication, inflammation control, and infection prevention. Elevating the head and applying a cold compress around the orbit post-surgery is recommended to reduce swelling.
Postoperative Prevention
Preventing postoperative dry eye aims to limit swelling, moisturize, lubricate, control inflammation, and prevent infection. Applying local antibiotics and steroid drops is advisable to prevent the inflammatory response and conjunctivitis.
If symptoms persist for more than 2 weeks post-blepharoplasty, a patient examination is crucial to identify the underlying cause and adjust treatment.
In cases where chemosis is absent, continued application of lubrication and typical corticosteroids is recommended. If symptoms persist for over 3 months, considering lacrimal punctal occlusion to maintain eye moistness can be beneficial.
CONCLUSION
The incidence of dry eye post cosmetic blepharoplasty is gradually rising. Dry eye significantly impacts patients’ quality of life. Modern examination methods, including measuring lipid layer thickness, are recommended to detect meibomian gland dysfunction and postoperative dry eye etiology.
Evaluation of patients’ spontaneous blinking patterns and their correlation with postoperative dry eye is important. Focus should be on reducing and preventing postoperative dry eye to improve patients’ quality of life.
Understanding and accounting for risk factors preoperatively, performing surgeries with care, and providing patient education are essential for preventing postoperative dry eye and protecting eye surfaces.
Acknowledgments
Foundations: Supported by the National Natural Science Foundation of China (No. 81770888; No. 81800873); the Shanghai Science and Technology Foundation (No. 17411963800); the Gaofeng Clinical Medicine Grant Support of Shanghai Education Commission (No. 20161421).
Conflicts of Interest: Zhang SS, None; Yan Y, None; Fu Y, None.
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