The Dry Eye Zone

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Abstract: Review of 892 blepharoplasties

Wow - lot of data went into this one.

Here's a simple takehome message for people considering blepharoplasty (eyelid surgery):

CONCLUSIONS Dry eye symptoms and chemosis are common following blepharoplasty...

So why do I get calls from so many blepharoplasty patients who say they had no idea this could happen? Is it the classic LASIK type "informed consent" breakdown, where the significance of the information escapes them because it's played down? Are they literally never told because the doctors performing the surgeries are oculoplastic docs who don't talk to their cornea colleagues enough or - worse - cosmetic surgeons who don't know or care about corneas in general?

Anyway, going back to the beginning... The study in question is a 10-year review of a whole bunch of eyelid surgery cases. Of those they were able to include in the study, about a quarter had dry eye and chemosis. There were also some specific risk factors that are worth reading about.



OBJECTIVES
To determine the incidence of and risk factors associated with dry eye symptoms (DES) and chemosis following upper or lower blepharoplasty. To examine the outcomes among long-term blepharoplasty data to better understand the incidence of and risk factors associated with dry eye symptoms (DES) and chemosis, to evaluate the known risk factors for DES in the general population, and to analyze intraoperative procedures (such as forehead-lift, midface-lift, canthopexy, and canthoplasty) to determine their effects on DES and chemosis.
 METHODS
A retrospective medical record review was performed among all the cases of upper or lower blepharoplasty performed by the senior author during a 10-year period (January 1999 through December 2009). A self-reported dry eye questionnaire was used to collect baseline and follow-up data. Patients with incomplete medical records, multiple (>1) revision procedures, less than 3 weeks of postoperative follow-up data, or a history of Sjögren syndrome, severe thyroid eye disease, histoplasmosis ocular infection, periocular trauma causing eyelid malposition, or radiotherapy for nasopharyngeal cancer were excluded from the study. Binary logistic regression analyses were performed to analyze the relationship between 13 preoperative and anatomical variables and DES or chemosis. χ2 Tests were performed to analyze the relationship between intraoperative risk factors and DES or chemosis.
 RESULTS
In total, 892 cases met the study inclusion criteria. Dry eye symptoms and chemosis following blepharoplasty were reported in 26.5% and 26.3% of patients, respectively. The incidences of DES and chemosis were significantly higher in patients who underwent concurrent upper and lower blepharoplasty (P < .001) and in patients who underwent skin-muscle flap blepharoplasty (P = .001). Hormone therapy use and preoperative scleral show were associated with DES after blepharoplasty (P < .05). Male sex, preoperative eyelid laxity, and preoperative DES were associated with an increased incidence of chemosis following blepharoplasty (P < .05). Intraoperative canthopexy significantly increased the risk for developing chemosis (P = .009), and postoperative lagophthalmos significantly increased the risk for DES following blepharoplasty (P < .001).
 CONCLUSIONS
Dry eye symptoms and chemosis are common following blepharoplasty, and the risk for developing these conditions may increase with intraoperative canthopexy, postoperative temporary lagophthalmos, concurrent upper and lower blepharoplasty, and transcutaneous approaches violating the orbicularis oculi muscle. Patients with a preoperative history of DES, eyelid laxity, scleral show, or hormone therapy use may be at greater risk for developing dry eyes or chemosis following surgery.

Arch Facial Plast Surg. 2012 Oct 15:1-8. doi: 10.1001/archfacial.2013.1. [Epub ahead of print]
Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW.

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