By Genevra Pittman
10:45 AM EDT, October 17, 2012
NEW YORK (Reuters Health) - More than one-quarter of people who've had an eyelid lift report symptoms of dry eye such as excessive watering and irritation, a new study suggests.
Researchers said that although dry eye symptoms are typically easily managed with eye drops or ointments, patients often don't talk about the issue unless they're asked specifically.
In rare cases, people can have hard-to-treat dry eye for years after an eyelid lift.
"It's something that's underreported and probably not discussed often enough with patients prior to surgery and after surgery," said lead researcher Dr. Jess Prischmann, a facial plastic surgeon from Edina, Minnesota.
However, "It's not a complication that should alarm people," she told Reuters Health. "The purpose of this study is not to scare people from getting blepharoplasty," the medical term for an eyelid lift.
She and her colleagues examined the medical records of 892 people who'd had an eyelid lift done by a single surgeon between 1999 and 2009. Those patients were asked about symptoms of dry eye on questionnaires before surgery and every two years during the following decade.
Almost 27 percent of them reported dry eye after surgery, and another 26 percent had swelling of the eye known as chemosis. Those side effects happened more often in people who'd had both upper and lower eyelid lifts. More aggressive surgical techniques also appeared to increase the risk of dry eye, according to findings published in the Archives of Facial Plastic Surgery.
Prischmann told Reuters Health there are a few explanations for why eyelid lifts might cause dry eye.
"When you have surgery on the eyelids, your blink mechanism is disrupted temporarily, and when you can't blink you can't spread that tear film over your cornea," she said. It's also possible, Prischmann added, that the tear film itself may change during a blepharoplasty.
According to the American Academy of Facial Plastic and Reconstructive Surgery, eyelid lifts run for an average of $3,500. In 2011, the procedures were the second most popular type of facial plastic surgery after nose jobs.
Dr. Richard Lisman, head of ophthalmic plastic surgery at New York University Medical Center, said most surgeons who do eyelid lifts are "very used to seeing dry eye" - and usually, it's not a serious problem.
"Dry eye is fairly common and most (cases) resolve. The trick here is to avoid those patients who are obviously set-ups for long-term dry eye that doesn't have an easy resolution, those patients that should have been turned down for surgery," Lisman, who wasn't involved in the new study, told Reuters Health.
He said a pre-surgery tear analysis can help spot people who might have the most trouble with dry eye down the line, but isn't necessary for everyone. Patients who might consider the test include women going through menopause or starting birth control pills, or people who have had difficulty with contact lenses in the past.
Most patients are "very happy" after an eyelid lift, according to Prischmann - and the new study doesn't mean people shouldn't get the procedures.
But she said surgeons should do a better job of talking to patients about the risk of dry eye beforehand and keeping on top of their symptoms after the surgery.
SOURCE: http://bit.ly/SZeRmW Archives of Facial Plastic Surgery, online October 15, 2012.
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