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  • Oculoplastics/Orbit

    This retrospective study found that dry eye symptoms and chemosis are common following blepharoplasty, and the risk for developing these conditions may increase with intraoperative canthopexy, postoperative temporary lagophthalmos, concurrent upper and lower blepharoplasty, and transcutaneous approaches violating the orbicularis oculi muscle. The authors also discovered that patients with a preoperative history of dry eye symptoms, eyelid laxity, scleral show or hormone therapy use may be at greater risk for developing dry eyes or chemosis following surgery.

    This is believed to be the first and most comprehensive study to analyze preoperative, intraoperative and postoperative factors and their relationship to dry eye symptoms and chemosis following upper and lower blepharoplasty. The study was a retrospective medical record review of all cases of upper or lower blepharoplasty performed by one of the authors from January 1999 through December 2009.

    Patients with a history of Sjogren syndrome, severe thyroid eye disease, histoplasmosis ocular infection, periocular trauma causing eyelid malposition or radiotherapy for nasopharyngeal cancer were excluded. A self-reported dry eye questionnaire was used to collect baseline and follow-up data.

    The results included data from 892 patients. Dry eye symptoms and chemosis following blepharoplasty were reported in 26.5 percent and 26.3 percent of patients, respectively. The incidences of dry eye symptoms and chemosis were significantly higher in patients who underwent concurrent upper and lower blepharoplasty (P < 0.001) and in patients who underwent skin-muscle flap blepharoplasty (P = 0.001).

    Hormone therapy use and preoperative scleral show were associated with dry eye symptoms after blepharoplasty (P < 0.05). Male sex, preoperative eyelid laxity and preoperative dry eye symptoms were associated with an increased incidence of chemosis following blepharoplasty (P < 0.05). Intraoperative canthopexy significantly increased the risk for developing chemosis (occurring in 45 percent with canthopexy vs. 25.5 percent without canthopexy, P = 0.009), and postoperative lagophthalmos significantly increased the risk for dry eye symptoms following blepharoplasty (42.3 percent with lagophthalmos vs. 22.9 percent without it, P < 0.001).

    The authors conclude that dry eye symptoms and chemosis are more common following blepharoplasty than previously reported. They say their findings complement other investigations suggesting that all patients undergoing blepharoplasty should have a preoperative risk factor assessment for chemosis, looking for scleral show, lagophthalmos, negative vector, previous surgery, positive snap test result, and dryness, grittiness, and pain. Their results indicate that this assessment should also include the variables of male sex, preoperative dry eye symptoms and preoperative eyelid laxity.