Preoperative Evaluation
Evaluation of any potential blepharoplasty patient includes the following:
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a complete ocular examination that includes visual acuity testing and documentation
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a history of prior periocular surgery
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identification of amount and areas of excess skin, as well as the amount and contours of prolapsed orbital fat, in the upper and lower eyelids
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presence or absence of lagophthalmos, which can lead to postoperative dryness and exposure keratopathy
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evaluation of tear secretion or the tear film, which may be carried out through Schirmer testing, tear breakup time, or assessment of the adequacy of the tear meniscus
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photographic documentation
Upper blepharoplasty
In addition to the assessments above, the examination before upper blepharoplasty includes the following elements:
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visual field testing to determine the presence and degree of superior visual field defects (if needed for documentation)
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evaluation of the forehead and eyebrows (including brow height and contour) to detect forehead and brow ptosis; the surgeon should make careful observations when the patient’s facial and brow musculature is relaxed
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notation of the position of the upper eyelid crease
Lower blepharoplasty
Preoperative examination for lower blepharoplasty further includes
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testing of the elasticity (snapback test) and distractibility of the lower eyelid; the surgeon should be alert to the possible need for horizontal tightening of the lower eyelids along with the blepharoplasty
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notation and discussion of prominent orbital rims, if present; malar hypoplasia or relative exophthalmos may predispose the patient to postoperative scleral show after lower blepharoplasty
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.