If I have dry eye, am I not a candidate to get eyelid surgery?

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!

Okay, 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:

• 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
• You may want to indicate to your surgeon that staying conservative would be your preference
• If you choose to have your surgery performed by an oculoplastic surgeon, this doctor is trained first and foremost as an ophthalmologist, and will likely perform a cornea/dry eye evaluation at the time of your plastic surgery consultation. However, if you choose to have your plastic surgery by a facial plastic surgeon or a general plastic surgeon (which are both well-trained, capable options), make sure to see an ophthalmologist for a general eye exam both before and after your surgery.
• There are many ways to treat dry eye—if your plastic surgery made your dry eye 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. Make sure you asking your ophthalmologist about all of these options.

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.