American Academy of Ophthalmology
Laser refractive surgery, including LASIK, is now a commonly performed procedure that continues to grow in popularity. The most common complaints after LASIK are dry eye symptoms. Blepharoplasty is a commonly performed eyelid procedure that can also result in dry eye symptoms postoperatively. In the June 2007 issue of Plastic and Reconstructive Surgery, Korn et al report a higher incidence of dry eye symptoms in patients who have undergone both blepharoplasty and LASIK. They also present guidelines to help avoid dry eye syndrome after blepharoplasty in patients who have already undergone LASIK surgery.
It is no surprise that patients who have undergone both blepharoplasty and LASIK are more prone to dry eye syndromes. Post-blepharoplasty patients can develop dry eye from lagophthalmos, eyelid retraction, weakening of the orbicularis oculi, and diminished blink speed and strength. Patients who have undergone LASIK can develop dry eye symptoms from decreased corneal sensation, decreased tear production, decreased tear clearance, and changes in eyelid positioning. The severe complications from dry eye syndrome can be avoided with careful preoperative screening of patients.
The first recommendation made by the researchers is to delay any eyelid surgery for at least 6 months after LASIK. It is commonly accepted that post-LASIK dry eye can result from decreased corneal sensation caused by the severing of the corneal nerves after creating the LASIK flap. The return of normal corneal sensation usually occurs after a period of 6 months. Patients are then thoroughly evaluated for any residual underlying dry eye signs and symptoms with Schirmer’s testing, tear breakup time, tear meniscus height, and corneal sensation measurements.
If a residual dry eye is identified, then artificial tear supplementation or punctal occlusion is performed, and blepharoplasty is delayed until the dry eye symptoms resolve. Even if there is no suggestion of a residual dry eye, Korn et al recommend performing a conservative blepharoplasty, minimizing fat excision and avoiding orbicularis oculi muscle removal. If concurrent blepharoptosis repair is also being performed, added caution should be taken.
For patients who have previously undergone blepharoplasty and who are now considering laser refractive surgery, Korn et al recommend an examination with careful attention given to the eyelid positioning. If lagophthalmos or eyelid retraction is present, the patients should be treated aggressively with artificial tear supplementation or punctal occlusion. Surgical repair of the eyelid malposition should also be performed prior to consideration of LASIK surgery.
Dry eye symptoms are common and can be very difficult to treat in a post-blepharoplasty or post-LASIK patient. The surgeon should carefully evaluate patients preoperatively if there is a prior history of either procedure. Surgery should be avoided if there are significant signs and symptoms suggesting dry eyes.
REFERENCE
Korn BS, Kikkawa DO, Schanzlin DJ. Blepharoplasty in the post-laser in situ keratomileusis patient: preoperative considerations to avoid dry eye syndrome. Plast Reconstr Surg. 2007;119(7):2232–2239.