Impact on Tear Film Production after Upper Lid Blepharoplasty
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Abstract
Background: The global population is aging, leading to increased incidence of dermatochalasis, a condition affecting the upper eyelids due to age-related changes in levator palpebrae superioris function. Upper eyelid blepharoplasty is a common surgical intervention to correct dermatochalasis, involving excision of excess skin and fat. Despite its benefits, concerns about postoperative dry eye syndrome persist, highlighting the need for further research in this area.
Design: This prospective cohort study aimed to evaluate the impact of upper eyelid blepharoplasty on tear production and stability in patients with dermatochalasis. Ten eyes from five female patients (mean age 69.50 ± 8.26 years) were included. Tear assessments were conducted preoperatively and at 2, 6, and 12 weeks postoperatively using the Schirmer test and tear breakup time (TBUT)
Methods: Patients scheduled for upper eyelid blepharoplasty were recruited at Thammasat University Hospital. Examinations included best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, Schirmer test, and TBUT. Exclusion criteria encompassed concurrent corneal diseases and certain pre-existing eye conditions.
Results: There were no statistically significant differences in Schirmer test measurements or TBUT between preoperative and postoperative assessments at 2, 6, and 12 weeks (p > 0.05). Mean Schirmer test values were 11.9 ± 8.99 mm preoperatively and 9.72 ± 3.55 mm at 12 weeks postoperatively. TBUT values were 9.11 ± 5.46 seconds preoperatively and 9.72 ± 3.55 seconds at 12 weeks postoperatively.
Conclusions: Upper eyelid blepharoplasty for dermatochalasis did not lead to significant changes in tear production or stability over a 12-week follow-up period. These findings suggest that careful surgical technique may preserve tear dynamics postoperatively. However, larger studies with diverse populations and longer follow-up durations are warranted to validate these results and assess potential long-term effects on ocular surface health.
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References
Lee R. The outlook for population growth. Science. 2011;333(6042):569-573. doi:10.1126/science.1208859
Kanasi E, Ayilavarapu S, Jones J. The aging population: demographics and the biology of aging. Periodontol 2000. 2016 Oct;72(1):13-8. doi: 10.1111/prd.12126. PMID: 27501488.
L.T. Jones, M.H. Quickert, J.L. Wobig The cure of ptosis by aponeurotic repair Arch Ophthalmol, 93 (1975), pp. 629-634
R.L. Anderson, C. Beard The levator aponeurosis. Attachments and their clinical significance Arch Ophthalmol, 95 (1977), pp. 1437-1441
Richards HS, Jenkinson E, Rumsey N, White P, Garrott H, Herbert H, Kalapesi F, Harrad RA. The psychological well-being and appearance concerns of patients presenting with ptosis. Eye (Lond). 2014 Mar;28(3):296-302. doi: 10.1038/eye.2013.264. Epub 2013 Dec 20. PMID: 24357840; PMCID: PMC3965808.
Yang P, Ko AC, Kikkawa DO, Korn BS. Upper Eyelid Blepharoplasty: Evaluation, Treatment, and Complication Minimization. Semin Plast Surg. 2017 Feb;31(1):51-57. doi: 10.1055/s-0037-1598628. PMID: 28255290; PMCID: PMC5330792.
Bhattacharjee K, Misra DK, Deori N. Updates on upper eyelid blepharoplasty. Indian J Ophthalmol. 2017;65(7):551-558. doi:10.4103/ijo.IJO_540_17
Olds C, Most SP. Upper Blepharoplasty. JAMA. 2019 Apr 2;321(13):1320. doi: 10.1001/jama.2019.1957. PMID: 30938797.
Morax S. Complications of blepharoplasty. J Fr Ophtalmol 2004;27:65874
Hollander MHJ, Contini M, Pott JW, Vissink A, Schepers RH, Jansma J. Functional outcomes of upper eyelid blepharoplasty: A systematic review. J Plast Reconstr Aesthet Surg. 2019 Feb;72(2):294-309.
Cosmetic Blepharoplasty, Joe Niamt, Cosmetic Facial Surgery, Mosby 2011, Eye South East Asia Vol.17 Issue 2 202235Pages 129-174, ISBN9780323074001, https://doi.org/10.1016/B978-0-323-07400-1.000075. (https://www.sciencedirect.com/science/article/pii/B978032307400 1000075)
Mack WP. Blepharoplasty complications. Facial Plast Surg. 2012 Jun;28(3):273-87. doi: 10.1055/s-0032-1312705. Epub 2012 Jun 21. PMID: 22723228.
Zhang SY, Yan Y, Fu Y. Cosmetic blepharoplasty and dry eye disease: a review of the incidence, clinical manifestations, mechanisms, and prevention. Int J Ophthalmol. 2020 Mar 18;13(3):488-492. doi: 10.18240/ijo.2020.03.18. PMID: 32309188; PMCID: PMC7154208.)
Turker IC, Dogan CU. Evaluating the Effects of Upper Eyelid Blepharoplasty on Tear Film Quality and Intraocular Pressure. Beyoglu Eye J. 2020 Dec 28;5(3):169-173. doi: 10.14744/bej.2020.81300. PMID: 35098083; PMCID: PMC8784458.
Shao C, Fu Y, Lu L, Chen J, Shen Q, Zhu H, Fan X. Dynamic changes of tear fluid after cosmetic transcutaneous lower blepharoplasty measured by optical coherence tomography. Am J Ophthalmol. 2014 Jul;158(1):55-63.e1. doi: 10.1016/j.ajo.2014.03.016. Epub 2014 Apr 4. PMID: 24709809.
Dailey RA , Saulny SM, Sullivan SA. Müller muscle-conjunctival resection: effect on tear production. Ophthal Plast Reconstr Surg 2002;18:4215.
Lima CG , Siqueira GB, Cardoso IH, Sant'Anna AE, Osaki MH. Evaluation of dry eye in before and after blepharoplasty. Arq Bras Oftalmol 2006;69:22732.
Belmonte C, Nichols JJ, Cox SM, Brock JA, Begley CG, Bereiter DA, Dartt DA, Galor A, Hamrah P, Ivanusic JJ, Jacobs DS, McNamara NA, Rosenblatt MI, Stapleton F, Wolffsohn JS. TFOS DEWS II pain and sensation report. Ocul Surf. 2017;15(3):404–437.
amawy AH, Farkas JP, Fagien S, Rohrich RJ. Preventing and managing dry eyes after periorbital surgery: a retrospective review. Plast Reconstr Surg. 2009;123(1):353–359.
Su YD, Liang QF, Su GY, Wang NL, Baudouin C, Labbé A. Spontaneous eye blink patterns in dry eye: clinical correlations. Invest Ophthalmol Vis Sci. 2018;59(12):5149–5156.