Dry eye after a recent eyelid surgery is not necessarily cause for alarm, but certainly something you and your doctor should monitor together and take steps to relieve. Eyelid surgery is a complex procedure that has many rewards and is considered very safe, yet it’s not without risk. This is the case of every medical treatment or surgery. It is likely that your surgeon discussed with you the possibility of dry eye and included this among the possible issues after surgery in your surgery consent. Hearing about it pre-surgically and experiencing post-surgically are two very different realities.
At the beginning of your post-operative healing, dry eyes, swelling, and lids not closing properly are common experiences, but usually these are temporary and naturally resolve as the swelling goes down and you heal. Think of your eyelids as windshield wipers that move tears over the eye surface. With surgery, the eyelids swell and function less well as tear movers contributing to dry eye sensation. The swelling generally subside sufficiently in the ten days after surgery to make a noticeable difference in eye comfort. However, swelling is not the only reason the eyelids may not function well. Certain eyelid surgeries actually injure the motor nerves to the orbicularis oculi muscle close to the eyelid margin. These injuries can be temporary or permanent and also effect how well the eyelids move tears over the eye surface. It seems that some of these injuries do get better with time but some persist and can permanently contribute to dry eye. Symptoms that persist longer than 6 months tend to be permanent. Because of this, we can think of post-operative experiences as immediate (within the first six months) and long-term (thereafter).
The way to address a concern over dry eyes depends on when you are experiencing this issue, and the actual basis for the symptoms. This means that a detailed eye exam by a board certified ophthalmologist is needed to assess these symptoms. Normal post-operative dryness can usually be helped with over-the-counter eye drops. We also strongly recommend you talk to your surgeon openly about your healing process and remain in regular communication. Dr. Steinsapir closely follows his patients to monitor their progress, answer questions, and be available to address any complication in the unlikely case that they arise. As we said, no surgery is without risk, and a surgery can tip a compensated dry eye. For this reason, Dr. Steinsapir recommends that eyes be thoroughly assessed before surgery to look for evidence of dry eye. Knowledge of the dry eye status before surgery should influence the surgeon to perform more conservative eyelid surgery, prompt a referral to a cornea specialist when needed prior to surgery, and in rare cases, recommend against eyelid surgery in the most severe cases.
In communicating with your surgeon, if artificial eye drops do not seem adequate, he or she may prescribe ophthalmic ointment before bed. In some cases, tear drains can be temporarily closed to improve symptoms. If these do not work, there are additional mechanical treatment options such as taping of the eyelids at night or swimming goggles at night in the most extreme cases. Long term when these measures do not provide sufficient relief, careful assessment for eyelid reconstruction may be indicated. The solution will depend upon your symptom severity, and the timing and precise anatomic cause of the problem. A range of options are available to improve eyelid closure with blink, which helps spread tears over the surface of the cornea and contributes to eye comfort.
If you wish to seek a second opinion, Dr. Steinsapir is available to assess your particular situation. He provides compassionate care whether you live locally or find it necessary to fly to Los Angeles for his assessment and input. He regularly helps individuals who require reconstructive surgery and corrections, and he is also thoroughly knowledgable on what to expect as part of the normal healing process. Your reconstructive surgery, when necessary, can be performed in his state of the art office based surgery center or on an outpatient basis at the Ronald Regan UCLA Medical Center, where is on staff. We invite you to call us today to schedule a time to discuss your particular concerns and options.
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 or surgeon 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.