The Dry Eye Zone

Did you know?


TFOS DEWS II (5).png

Did you know? Lid lifts can cause dry eye.

Did you know?

Eyelid surgeries are a common cause of dry eye - but it often goes undiagnosed.

TFOS DEWS II Iatrogenic Dry Eye report, section

Lid surgery causing DED onset or worsening preoperative dry eye [265–269], is common but underdiagnosed [270]. Prischmann et al. documented DED in 26.5% of 892 patients following blepharoplasty (the excision of skin, orbicularis oculi muscle and/or orbital fat) [271]. In a retrospective study by Saadat et al., only 5 of 60 patients (8.0%) with preoperative DED worsened following blepharoplasty [267]. Risk factors for dry eye symptoms following blepharoplasty include Bell's phenomenon, previous LASIK surgery, concurrent upper and lower blepharoplasty, skin-muscle flap blepharoplasty, hormone replacement therapy use, preoperative scleral show and postoperative lagophthalmos [271,272]. After ptosis surgery, both normal tear function [273–279] and dry eye [280–286] have been reported.


Take the hint… if you are determined to get lid surgery, make sure you go to an oculoplastic surgeon (not simply a plastic surgeon, no matter how reputable).

Close interaction of the eyelids, tear film and ocular surface makes effective lubrication susceptible to surgery-related changes [266,270,287–289]. As a result, a thorough knowledge of the eyelids' complex anatomical structure and function is mandatory to prevent inadvertent injury and to ensure effective tear film function post-surgery [269,290,291]. Lid surgery can seriously affect eyelid closure or position [288,292,293]. Symptoms occur secondary to exposure, leading to an increased tear evaporation rate and drying of the ocular surface, especially in poor Bell's phenomenon [291,294]. The cause of dysfunctional eyelid closure may be readily diagnosed in the presence of lagophthalmos, scleral show or ectropion [290,295]. Poor postoperative eyelid closure results from skin and/or muscle deficiency (anterior lamella) or intrinsic eyelid stiffness secondary to cicatricial changes within the middle and posterior lamella (orbital septum, lid retractors, conjunctiva) [290,291]. Eyelid dysfunction may also relate to the onset and persistence of chemosis and thus increase the risk of corneal and conjunctival exposure [288,296,297]. Dysfunction and/or dehiscence of the lateral canthus is another source of symptomatic eyelid closure disorder and an overlooked postblepharoplasty complication [288,295].