Do I have Dry Eye?
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.
One of the most common contributors to dry eye is a condition called blepharitis. Blepharitis is a plugging up and low grade inflammation of the oil glands that line the eyelid margin. When this results in a lack of oil secreted in the tear film, tears can evaporate off the eye surface more easily and lead to dryness.
Whatever the cause of dry eye, it can be a tricky entity to treat. A stepwise approach is usually recommended, starting with artificial tear eyedrops. If one has blepharitis, the combination of warm compresses and eyelid scrubs can help dry eye as well. If these regimens fail to work, the placement of plugs in the tear ducts (to keep the tears around longer) and/or prescription eyedrops that decrease low grade inflammation in the eye might be recommended.
You are interested in eyelid surgery…but you have dry eye. Does that change anything?
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 surgeries that one can undergo. It is a relatively straight-forward, often in-office procedure that 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.
Upper lid blepharoplasty removes redundant eyelid skin on the upper eyelid, giving a more youthful appearance. But it also raises the place where the upper eyelid meets the eye, which can cause more of the cornea (the anterior clear structure of the eye) to be exposed. As you can imagine, when more of the cornea is exposed to the air, the greater the risk that 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. This becomes especially problematic when we sleep; if too much skin is removed from the upper eyelids, major dry eye complications on the inferior portion of the eye may result.
It is therefore extremely important to let your surgeon know if you have issues with dry eye, so that the proper amount of skin is removed to give you a youthful appearance, while making sure the eyelid can still close and doesn't lift too much.
Things to think about if you have dry eye and are considering eyelid surgery:
- If you currently use artificial tears or lubricating ointment to keep your eyes comfortable, you will definitely need to continue this regimen after surgery and possibly increase the frequency.
- Let your surgeon know that you have dry eye! This will help set expectations on the appropriate degree of eye lift that will give you the best aesthetic and functional result.
- See an ophthalmologist for a general eye exam including cornea/dry eye evaluation both before and after your surgery. An oculoplastic surgeon is a trained ophthalmologist and can perform this evaluation as well.
- If your surgery makes your dry eye persistently more symptomatic, some of your options include artificial tears, lubricating ointments, eyedrops medications such as RESTASIS® or Xiidra® , or even the placement of punctal plugs. Consult with your ophthalmologist to identify the best treatment option for you.
1. Naik MN, et al. Blepharoplasty: an overview. Journal of Cutaneous and Aesthetic Surgery 2009: 6–11.
2. Saadat D, et al. Safety of blepharoplasty in patients with preoperative dry eyes. Arch Facial Plast Surg. 2004;6(2): 101-4.
By 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.
Link to her practice here: www.mpomg.com/lids