The Dry Eye Zone

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Medical news: Ophthalmologists should be involved before eyelid surgery

Yes, yes, yes!!! The more awareness about this we can get among plastic and oculoplastic surgeons the better.

The gist of the report - well, of the part I'm interested in - is that people getting eyelid surgery by a plastic surgeon really need an ophthalmologist involved in evaluation and surgical planning... Dry eye risk from changes to the lids being of course a key consideration especially in anyone who already has dry eye and/or who has had laser eye surgery.

Ocular Surgery News, August 2008
Preop exams by ophthalmologists urged before oculoplastic surgery

Dr. Lucchini said plastic surgeons who operate on the eye should evaluate the patient’s visual function, even in simple ways such as covering, in turn, one of the patient’s eyes and asking him or her to look at distant objects. In cases of evident or suspected visual defects, a more professional evaluation by an ophthalmologist is advisable.

“Evaluating and documenting preoperative vision protects the surgeon from any medical-legal accusation of having compromised the patient’s visual function,” he said.

Tear film integrity should also be assessed, taking into account that about 20% of the population in Europe and the United States suffer from some kind of tear film alteration because of contact lens use, allergies or systemic disorders such as Sjögren’s syndrome.

“Tear film dysfunction is one of the most common causes of patient dissatisfaction or discomfort following eyelid surgery,” Dr. Lucchini said. “Patients often complain of dry eyes and burning sensations. This most often comes from a preoperative alteration of the tear film, which has been worsened or made symptomatic by the operation because, for some time after surgery, the eyes don’t close properly.”

A Schirmer’s test performed preoperatively will show if the tear production is normal, and the patient’s history will provide additional information on potential causes of tear film alterations.

“Patients who are taking antidepressants or benzodiazepines … may have alterations, both in the quantity and quality of tears,” he said.

Also, contact lens wearers, particularly those who show signs of contact lens intolerance, are likely to have an abnormal tear secretion.

In patients who have previously undergone corneal refractive surgery, whether surface ablation or LASIK, tear production is altered for 1 year or more after the treatment, Dr. Lucchini said.

“These are not necessarily exclusion criteria, but just a warning that some problems may occur over the first weeks following oculoplasty. Patients should be made aware of this possibility before they sign their consent,” he said.


Incidentally, this was kind of an interesting quote - it is certainly in agreement with my experience of all the surface ablation patients we get on the bulletin boards, though it's directly at variance with how ASA is marketed these days:

In patients who have previously undergone corneal refractive surgery, whether surface ablation or LASIK, tear production is altered for 1 year or more after the treatment, Dr. Lucchini said.
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