Eyelid surgery is a delicate operation that has as many rewards, but it is still surgery and requires adequate healing time. As you begin to heal, you may notice problems with dry eyes, or your lids not closing properly. Immediately after surgery and for about ten days following, swelling may cause discomfort and concern about the new position of your lids. However, as your body heals, your lids may resume a more natural position. There is a small risk that the nerve fibers that supply the muscle that closes the eye (orbicularis oculi muscle), may be temporarily or permanently weakened causing long-term eye surface drying and dry-eye symptoms. Six weeks following surgery is too early to become alarmed, but Dr. Steinsapir strongly recommends visiting your original surgeon for a complete assessment of your condition to determine your treatment options. If your surgeon is not a fellowship trained oculoplastic surgeon, you may need to see one or a cornea specialist.
Why won’t my eyes close?
Surgery can produce long-term damage to the function of the eyelids causing dry eye symptoms. If your surgeon removes too much upper eyelid skin and underlying muscle, your eyes may not close completely, causing dry spots to develop on the cornea. Depending of the design of the blepharoplasty, the nerves that supply the muscle that helps to close the eye can be damaged weakening the blink reflex. This means that during a blink there may not be sufficient speed or force to cause the upper and lower eyelids to meet during the blink. Since the eyelids move tears on the eye surface around, the net result is surface drying.
What are my treatment options?
The first line approach to treating these issues is to increase the frequency of artificial eye drops and, when indicated, ophthalmic ointment at bedtime. If necessary, your tear drains in your eyelids can be closed temporarily with plugs to see if symptoms improve. If these measures fail, there are some additional mechanical measures available. Depending on the corneal status early surgical reconstruction may be necessary.
The extent of the solution depends on the severity of the symptoms and the degree of drying seen on the surface of the cornea. Although a range of options are available, the key objective is to make the eyelids meet and to create sufficient force of eyelid closure to help spread the tears over the corneal surface.
Is this a long-term issue?
Common post-operative issues can be thought of in two broad categories: immediate and long term. Immediate issues are post-operative issues and complications that present anytime from moments after surgery up to six months. Long-term complications are issues that continue to persist beyond six months. The six-month time frame is useful because a number of concerns related to difficulty closing the eye and mild lower eyelid retraction often resolve spontaneously in this time frame. In contrast, it is Dr. Steinsapir’s experience that when these types of problems are present six months after surgery and continue to be a concern, then they often need to be addressed with a corrective surgery.
I chose an experienced surgeon, what happened?
No matter how technically superb the surgeon, surgery can tip a marginally compensated dry eye to discomfort. Unpredictable individual factors may also contribute to a particular situation. Dr. Steinsapir is acutely aware of the importance of eye comfort after surgery and what steps are needed to make the eye as comfortable as possible. Unfortunately, specialists lacking the training in Ophthalmology can underestimate the impact of these easily addressed issues. For this reason, Dr. Steinsapir closely follows his patients after surgery. Your post-operative follow-up schedule is based on how you are actually doing rather than on a scheduled based on how everyone one else has done in the past.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.




