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    Bye-bye dry eye

    Eye surgeons have options for predicting and circumventing keratoconjunctivitis sicca

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    Dr. Binder
    Keratoconjunctivitis sicca, or dry eye, is a common condition frequently seen by ophthalmologists — and by cosmetic surgeons. Patients who undergo a blepharoplasty often complain of dry eye symptoms, and, unfortunately, this condition can be very challenging to treat. According to one expert, measured prudence, pre-operative foresight, and post-operative care in dealing with the blepharoplasty patient can help to alleviate symptoms of dry eye and avoid exacerbating the condition — especially in those already prone to developing it.

    Whether due to an innate predisposition, the orbital and periorbital anatomy of the patient, or a LASIK or blepharoplasty procedure, keratoconjunctivitis sicca is bothersome for those who develop this condition. Moreover, patients who have previously undergone these procedures are even more prone to developing dry eye symptoms. Blepharoplasty patients can develop dry eye symptoms as a result of post-operative lagophthalmus, eyelid retraction, weakening of the orbicularis oculi, as well as due to diminished blink speed and strength.

    Patients who suffer from dry eye symptoms either do not have a sufficient production of tears or the correct composition of tears on the surface of the cornea to lubricate the eyes. Common complaints can include a persistent ocular irritation, itchiness, dryness, foreign-body sensation, fatigue and visual disturbances. Patients with more severe dry eye symptoms are at risk of developing corneal infection, scarring or ulceration, which can culminate in permanent loss of vision. Hence, an active and aggressive prevention of dry eye symptoms is paramount.

    PREDICTIVE ANATOMY According to Gregory S. LaTrenta, M.D., a plastic surgeon and clinical associate professor of surgery at the Joan and Sanford Weill Medical College of Cornell University in New York, the orbital and periorbital anatomy of post-blepharoplasty dry eye patients plays a central role in predicting whether or not a patient will develop the condition.

    "People who have very large eyes where you can see much of their globe are undoubtedly more prone to develop dry eye symptoms following a blepharoplasty procedure," Dr. LaTrenta tells Cosmetic Surgery Times , referring to the orbital and periorbital morphology of a patient's eyes. "The more white of the eye you see pre-operatively, the more of the cornea is exposed," Dr. LaTrenta explains. Therefore, a blepharoplasty, which could enlarge the aperture of the eye, could potentially place a patient already prone to dry eye symptoms into a state of even dryer eyes.

    According to Dr. LaTrenta, the eyes of patients who have a lot of cornea exposed are termed morphologically prone eyes, a positive vector eye, or a proptotic eye — and can be a warning sign for dry eye symptoms. He says that eye surgeons must be aware of this and act accordingly.

    PRE-SCREEN POINTERS "All patients that may seem to be prone to dry eye should have an evaluation from an ophthalmologist pre-operatively," Dr. LaTrenta emphasizes. "This is one important step in the prevention of dry eye symptoms."

    In his opinion, a Schirmer's test is the best test to ascertain the potential for dry eye and should be performed to help identify patients with diminished tear production before the blepharoplasty. "This simple test can be pivotal in the decision to operate or not," Dr. LaTrenta asserts. However, he adds that although a Schirmer's test is a critical pre-operative exam that should be performed on all prospective blepharoplasty patients, the test should not be relied on as the sole method of screening potential patients.

    According to Dr. LaTrenta, the most important step to take prior to a blepharoplasty procedure is to coordinate the surgical intervention with an ophthalmologist. It is paramount that the ophthalmologist evaluates the patient both pre- and post-operatively, as he believes that ophthalmologists' supplemental knowledge can help to ensure that the blepharoplasty runs as smoothly as possible.

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