How Dry Eyes are Best Managed when Having Cosmetic Eyelid Surgery

How Dry Eyes are Best Managed when Having Cosmetic Eyelid Surgery


Many people who suffer from dry eyes can potentially
benefit eyelid surgery to treat under eye bags, hooded upper eyelids, or eyelid ptosis. At the same time if you have dry eyes, you
may be hesitant about surgery because of potential surgery related causes which may make dry
eyes worse . In this video, I will explain how I approach patients with dry eyes in my
practice, and how eyelid surgery can be done for many patients with dry eyes. I’m Dr. Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and
Fellowship Trained Oculofacial Plastic & Reconstructive Surgeon. I’ve been in practice in Manhattan and Long
Island for over 20 years. To be an oculoplastic surgeon, you have to
first be trained in ophthalmology (B roll Dr P using a slit lamp). As an oculoplastic surgeon, I have expertise
with disorders of the lacrimal system, which includes the lacrimal gland, which produces
tears and the tear duct system, which drain the tears. This background informs all cosmetic surgery
I perform in the eye area. It is often the case where a general plastic
surgeon performs eyelid surgery, and then sends the patient to an ophthalmologist once
the patient complains of dry eye symptoms. The plastic surgeon essentially puts the burden
of the surgical outcome onto the ophthalmologist is now put in a difficult position of having
to manage the patient’s dry eyes for years long after the plastic surgeon compromised
the eyelid function. A systematic approach to identifying the degree
of dry eye prior to surgery is very important. Further, I would add that specific aspects
of eyelid anatomy directly affects eyelid function and will impact future dry eye management. For example, lower eyelid surgery for eye
bag removal is a very popular procedure. The lower eyelid is very important for proper
distribution of tears over the eyes. You can think this interaction of the action
of the upper and lower eyelids to be working like a windshield wiper to evenly distribute
tears over the surface of the eyes. If there is any change in the anatomy of the
lower eyelid, particularly the position of the eyelid margin, this tear distribution
function will be impacted For example, a very commonly performed technique
for lower eyelid surgery is the transcutaneous method, where an incision is made below the
eyelashes to remove and sculpt the fat which cause eye bags. It’s common practice to also remove skin
at the same time in an attempt to improve fine lines and wrinkles under the eyes. Without managing the critical structural support
of the lower eyelid, this technique often compromises the position of the lower eyelid
as well as its function. The result is a pulled down appearance referred
to as lower eyelid retraction, which can cause an inability to fully close the eyes resulting
in eye exposure and dryness. Tear film distribution is also compromised. For primary lower eyelid surgery for under
eye bags, I evaluate the anatomy and function of the lower eyelid using what’s called
a pull test and a snap back test. These tests help me decide if any additional
support procedures would be appropriate such as a lateral tarsal strip to position the
lower eyelid for optimal tear distribution. My preferred approach to addressing lower
eyelid fat pockets is called a transconjunctival lower eyelid blepharoplasty. This means I address the fat pockets from
inside of the eyelid. This technique better preserves lower eyelid
support structures in particular the support muscle called the orbicularis oculi and maintain
the position of the eyelid margin. This means the tear distribution is properly
maintained. I routinely perform this surgery on patients
with dry eyes, even those with a history of severe dry eyes. Additionally, my patients appreciate that
there is no visible external scar and the natural shape of the eyes are maintained. Oftentimes people who have dry eyes will actually
have improvement in their dry eye symptoms after eyelid surgery. This is because procedures which improve the
tone and position of the lower eyelid combined with the relief of weight from extra skin
on the upper eyelid help the eyelids protect and lubricate the eyes. Eyes that look good function well. When it comes to upper eyelid blepharoplasty,
it’s critically important to not remove too much skin, particularly in patients with
dry eyes. I would also add that with upper eyelid surgery,
particular care must be taken to protect a gland, which produces tears called the lacrimal
gland. The lacrimal gland exists in the same space
where the fat pockets in the upper eyelid are present. When the upper eyelids appear full and heavy,
both the fat and the lacrimal gland can be responsible for this appearance. It’s routine to sculpt and remove some fat
to create more space. Unfortunately, it’s been well known that
the lacrimal gland has been mistakenly removed by general plastic surgeons which resulted
in significant loss of tear production. As an oculoplastic surgeon, during evaluation
as well as during surgery I look for the lacrimal gland which is often prolapsed or displaced
downward. Instead of removing the lacrimal gland, I
perform a procedure called lacrimal gland resuspension to restore the anatomical position
of the lacrimal gland as well as preserve the function of the lacrimal gland. It’s important to have a clear strategy
for dry eye management before and after surgery. It’s well established that there may be
some short term decrease in tear production after eyelid surgery so generally, I advise
my dry eye patients to increase the frequency of lubricating eye drop use prior to surgery. Further, I work with my patients to help them
with dry eye management after surgery. As far as the anesthesia experience, I perform
all my eyelid surgeries with local anesthesia with LITE sedation. My patients recover comfortably and quickly
so they typically are able to return to work in about 1 week. Cosmetic eyelid surgery can be done safely
for people with dry eyes. As mentioned earlier, there are often opportunities
to help improve dry eye symptoms with specific procedures, which are well known to oculoplastic
surgeons. I would state without reservation that a cosmetic
eyelid surgery specialist with training in ophthalmology is ideally suited to perform
cosmetic surgery for people with dry syndrome. I hope you found this information helpful…thank
you for your question

About the Author: Earl Hamill

8 Comments

  1. Hi dear doctor,

    Does finasteride cause elevated liver enzymes?

    Male | 25 old | No smoke no drink

    Before I start taking finasteride 1mg/day.

    My blood test value was:

    ALP: 69.1 (44.0 – 174.0)

    ALT: 35.2 (5.0 – 40.0)

    AST: 21.5 (5.0 – 40.0)

    Bilirubin: 0.80 (0.10 – 1.20)

    After 2 month on finasteride 1mg/day.

    My blood test value is:

    ALP: 65.3 (44.0 – 174.0)

    ALT: 257.1 (5.0 – 40.0)

    AST: 172.7 (5.0 – 40.0)

    Bilirubin: 6.68 (0.10 – 1.20)

    Hepatitis and HIV are negative.

    Other blood tests are in normal range.

    I know that I have to visit my doctor (and I will), but I ask you because you know everything about finasteride. So please according to your experience, does finasteride cause elevated liver enzymes?

    After week 6 on Fin + Rogaine my hair start growing again.

  2. Dr, I got a lower eyelid retraction (making me eyes appear large) and hooded eyes on upper eyelid. It’s making my appearance look weird and if I was to get surgery what one should I go for??

  3. Does pet bird cause allargie?? I have a cockatiel in my room and i'm facing problem of allargie.. Plz reply

  4. Hi doctor after ptosis surgery my eye is not closing completely while I'm sleeping. I done with Ptosis surgery more than a week ago and my doctor merge with forehead muscles and my eyebrows are also not equals now there is a difrrence in half eye brows i mean half eyebrows are slightly low than the other while doctor is saying that after the passage of time swelling and others things well be also fine.. Plz doctor tell me it is a issue or it is fine??

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