Successful surgery and prevention of persistent dry eyes entails(1) proper understanding of tear film anatomy physiology(2) preoperative recognition of risk factors through the history and physical examination(3) intraoperative maneuvers to maximize prevention(4) immediate and aggressive postoperative management.
Staging the upper and lower blepharoplasties in two separate operations may be considered.Corneal protection is an obvious, often overlooked aspect of blepharoplasty.Trauma or, more importantly, prolonged exposure can lead to corneal abrasion or ulceration.Conservative excision is critical. This entails accurate measurement with a caliper and leaving 8 to 9 mm in the pretarsal fold when performing an upper blepharoplasty.Skin resection in the lower blepharoplasty should be more conservative, taking into account that even if there is no lower lid retraction after resection, postoperative healing and scarring may eventually pull a lax lid down.The orbicularis oculi muscle should be preserved in both upper and lower blepharoplasty. Special attention is paid to not injure the innervation as well. Disruption may lead to a decreased blink rate and is a setup for evaporative tear loss.Canthopexy to correct lateral canthal depression and protect against ectropion is a safe measure that may be performed.
Edema may be controlled with head elevation and periorbital cool compresses.Immediately after surgery, normal tear film production is disrupted and may take several days to recover. Liberal use of artificial tears during the day and lubrication at night protect the eyes during this period.Topical antibiotic and steroid (TobraDex; Alcon Labs, Fort Worth, Texas) drops help in reducing the inflammatory response and preventing conjunctivitis.The systemic steroids are also continued by tapering oral corticosteroids over 5 days (Medrol Dosepak; Upjohn Co., Kalamazoo, Mich