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Preventing and Managing Dry Eyes after Periorbital Surgery: A Retrospective Review

Hamawy, Adam H. M.D.; Farkas, Jordan P. M.D.; Fagien, Steven M.D.; Rohrich, Rod J. M.D.

Plastic and Reconstructive Surgery: January 2009 - Volume 123 - Issue 1 - p 353-359
doi: 10.1097/PRS.0b013e31819346ea
Cosmetic: Original Articles

Background: Dry eye syndrome is a common sequela associated with periorbital surgery. As more patients seek periorbital rejuvenation, understanding the pathophysiology, diagnosis, and treatment of this condition perioperatively is essential for managing patient expectations and maximizing outcomes.

Methods: A retrospective review of charts for 202 consecutive patients (180 women and 22 men) who underwent upper and/or lower blepharoplasty was performed. Additional facial cosmetic procedures were performed in 91 percent of patients. Data were collected identifying associated risk factors and the incidence of persistent dry eye symptoms. Key elements of perioperative care are described and algorithms for detection of those at risk, prevention, and management are outlined.

Results: Dry eyes persisting longer than 2 weeks after surgery were noted in 22 patients (10.9 percent) and longer than 2 months in only four patients (2 percent). In most cases, dry eyes resolved with conservative management, including artificial tears, lubrication, topical and systemic steroids, and night taping. One patient (0.5 percent of all studied patients) eventually needed surgical correction of lower eyelid retraction after failure of the punctate plug. Persistent chemosis occurred in 15 patients (68.2 percent) who had symptomatic dry eyes (p < 0.01).

Conclusion: Recognizing and addressing risk factors before surgery and an algorithmic approach to prevention and management of patients undergoing periorbital surgery are essential for minimizing the occurrence of dry eye syndrome.

Dallas, Texas; and Boca Raton, Fla.

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, and Aesthetic Eyelid Plastic Surgery.

Received for publication January 15, 2008; accepted July 9, 2008.

Presented at the Texas Society of Plastic Surgeons Annual Meeting, in Austin, Texas, September 28 through 30, 2007.

Disclosure: None of the authors has any commercial association or financial relationships that might pose or create a conflict of interest with the information presented in this article. The views and conclusions expressed are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States government.

Rod J. Rohrich, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical School, 1801 Inwood Road, 4th Floor, Dallas, Texas 75390-9132,

©2009American Society of Plastic Surgeons