Thank you for your question.
You are asking about tear production test for a lower eyelid blepharoplasty and you
state in your question that your surgeon is insisting that you get this test about tear
production before you have lower eyelid blepharoplasty and you are asking about how comfortable it
is.
Well, I can certainly give you some perspective on this concern your doctor has.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years and this concern
about dry eye after lower eyelid surgery is something that you should actually appreciate
your doctor being concerned about.
Now, I’ll explain why.
One of the most deceptively complicated surgeries is lower eyelid blepharoplasty.
The lower eyelid is very important in the function of tear distribution over the eyeball,
the eye itself, the cornea.
And unfortunately, a lot of times people after lower eyelid surgery will have some degree
of eyelid retraction as well as dry eye problems.
As an oculofacial cosmetic surgeon and this is an actual area of focus and specialty,
I treat people from all over the world with lower eyelid retraction, ectropion and incomplete
eye closure, problems with dry eyes and it is a very challenging issue to deal with.
Now, that isn’t meant to scare you off from having this surgery but it has become at least
an awareness of some very thoughtful plastic surgeons to at least have an ophthalmic exam
for their patients before the procedure and they want to know if you already have dry
eyes and hopefully that will guide them how they do the surgery.
Now as far as the evaluation is concerned, an ophthalmologic examination is not just
about a single test but the test they’re talking about is the Schirmer's test.
And Schirmer's test is a test which has been around forever in ophthalmology and that’s
the point.
I’m an oculofacial plastic surgeon.
I first did my residency in Ophthalmology before plastic surgery of the eyes and face.
This is a little strip of paper that is put just at the eyelid and basically measures
how much tears are produced.
Now it is not a perfect test because if you have the slightest bit of discomfort with
the placement, your eye produces a lot more reflexive tears which means that the paper
gets more soaked and looks like you have more baseline tears than you actually do.
But also, the ophthalmologist looks with an instrument slit lamp at the tear film and
your baseline and the health of your eyes.
So, I would advise you to follow your doctor’s recommendation and have your eyes checked
for dry eye and it doesn’t mean that people with dry eye can’t have eyelid surgery.
In fact, as a specialist, people who have severe dry eye, Sjogren’s syndrome, rheumatoid
arthritis, many types of different issues have come to me because of my background and
my knowledge of how to manage their dry eyes.
Oculoplastic surgery is eyelids, orbit and lacrimal system so we know a lot about the
tear production and tear drainage system.
On top of that, it is also important, if you do have dry eye, it is fairly generally straightforward
to manage dry eyes.
We use artificial drops for lubrication to just keep the eyes moist and I generally recommend
that if people have a history of dry eye that should be more vigorous about treating their
dry eyes before the surgery so that in case during surgery, if they have some prolonged
exposure of the eyes, they have a little bit of moisturization on board.
And of course afterwards, it is important to be adherent to the dry eye treatment schedule.
So move forward and again I highly recommend that you move forward with the dry eye evaluation
and discuss this with your doctor in terms of the overall game plan would be once the
evaluation is completed.
So I hope that was helpful, I wish you the best of luck and thank you for your question.