The Dry Eye Zone

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Abstract: Blepharoplasty complications: blah blah blah DRY EYE blah blah blah


Dear oculoplastic surgeon:

I understand and accept that medical professionals and medical journals necessarily have their own special vernacular. It is with the greatest respect that I would like to gently encourage you to employ that vernacular in its proper context and exercise vigilence to prevent it from creeping into communications during clinic with evidently distressed ocular surface disease patients - such as your recent bleph patient whose lids through no fault of yours unfortunately ended up a bit on the short side. Such patients have quite a different vocabulary and may not understand yours.

Some post blepharoplasty dry eye syndrome patients experience extreme surface pain with resulting disruptions to certain incidental life activities, such as sleeping, working, reading and driving. These patients may or may not have dramatic ocular surface signs, but they have symptoms in spades. In such cases, employing phrases like "minor complication" could interfere with your ability to maintain an excellent (or perhaps any) relationship with this patient. Naturally, these patients understand that blindness is worse, but, strange to say, it may not be a comfort to them when you say so.

Trust me, I know. I'm the one they call when they get desperate and go scouring the internet for the help you are not offering them.

Speaking of which, if all you can do is tell them to use drops and ointments, please don't be offended when I ask what rock you are living under? There are a ton of excellent products out there to help these patients. It is astonishing to me how frequently I get calls from patients who in the very best case may have been hesitantly told that Saran Wrap might help if the Refresh PM didn't cut it on its own. If you don't have time to learn about products for night eye protection, does the corneal specialist in your practice? If not, give them a nudge. Something will help this patient - perhaps a Tranquileyes moisture goggle, a bandage contact lens for night use, a sleep mask, a skin-friendly tape, Dwelle, Genteal Gel, an Onyix shield, even a post LASIK style goggle - something will help.

A significant number of these patients will end up severely clinically depressed for the first time in their lives - all due to unremitting corneal pain poorly understood and inadequately addressed. Please, step in and prevent this escalation: do a little homework on what might help. You can't expect every company to show up on your doorstep with a solution to every problem. If you're new to this and don't know where to start, I'm here - call me.



Minor complications after blepharoplasty: dry eyes, chemosis, granulomas, ptosis, and scleral show.
Plast Reconstr Surg. 2010 Feb;125(2):709-18.
Pacella SJ, Codner MA.
Division of Plastic Surgery, Scripps Clinic and Research Institute, and Paces Plastic Surgery, La Jolla, Calif, USA.

SUMMARY: Blepharoplasty remains one of the most popular operations in facial aesthetic surgery. Serious complications, which include blindness, retrobulbar hematoma, and ectropion, although relatively rare, are well reported in the literature. As techniques evolve in aesthetic eyelid surgery, minor complications continue to be very common. Nonetheless, management of these complications can be challenging and may require extended management or surgical revision. The authors discuss several of the most common minor complications, including hematoma, dry-eye syndrome, infections, atypical lesions, lid malposition, and scarring. In addition, preoperative assessment of risk factors, treatment, and management of these minor complications are presented.
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