Thank you for your question.
You submitted your question with several photos.
And you are describing in your question a situation where you’re 2 months post op
after undergoing Asian eyelid surgery and epicanthoplasty.
And you describe in the details of your question that you have been having difficulty with
eye closure and dry eye and irritation to the point where you are unable to wear your
contact lenses.
Your eye doctor prescribed you Restasis and lubricating drops.
And you’re stating that your doctor is not taking this very seriously and is being dismissive.
And further, you are questioning whether or not you should be seen by an oculoplastic
surgeon for further evaluation.
I can certainly share with you a perspective as an oculoplastic surgeon with situations
like yours in the absence of course of a physical exam.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Asian eyelid surgery is a very significant part of my practice.
I also specialize in revision eyelid surgery as well as a wide range of both the non-incisional
and incisional techniques and of course epicanthoplasty.
So certainly, I’m quite familiar with your type of procedure.
That being said, I would say that there are certain issues that are important in a situation
like yours that I think do deserve attention.
It looks like you are on the right path.
To begin with, it is in my opinion, it is generally well accepted in the oculoplastic
community, these are surgeons specializing in eyelid surgery who also trained in eye
surgery in ophthalmology, that eyelids that look good function well.
And so, there has been a perception in the general plastic surgery community to some
degree that it is a norm to have difficulties in eye closure and dryness after surgery.
So to give you some clarity as to how I advise my patients or at least a perspective, I basically
explain that any surgery around the eyes can temporarily cause some degree of dryness.
Now this is more of a function of the possible reduction of baseline tear production from
any procedure occurring around the eyes.
So for my contact lens patients, I often say make sure that if you are, particularly if
you have a very high prescription where you really need to wear contact lenses that you
have your contact lenses available but wear them with a lot of lubricating drops and see
if you can tolerate that.
And again, between that, also providing yourself with lubrication of the eyes with artificial
tears.
Now given that you are having a challenge with eye closure, that you also describe as
improving since the previous month, this is particularly important not so much during
the day.
We would describe this as forced blinking where you’re awake and aware and you blink
your eyes to compensate for dryness.
But I would say that it is also important to also be aware of what your eyelid opening
is and if it opens passively at night when you sleep.
I often recommend when a patient comes in for a consultation or second opinion for difficulty
for eyelid closure, I recommend the use of an ophthalmic lubricating gel at night to
allow for proper lubrication because when the eyelid is gapped, there’s going to be
evaporation of tears and would result in more irritation.
Further, I also recommend the typical dry eye management strategies, not only just lubricating
drops but I also tell patients to put a humidifier in their room when they’re sleeping just
to add some moisture to the ambient air.
That’s for the management for the eye exposure.
Now the question now is there really a relative skin shortage or is this a manifestation of
just short-term muscle being affected or the nerves that affect eye closure.
Now it is difficult right now to make that determination based on the photos you submitted.
And it is not unusual for someone to have these symptoms at this point even though there
might be either a slight skin shortage and some degree of nerve dysfunction after this
surgery.
Over the course of several months, the area does get better.
The function does improve.
So the key of this strategy whether you see an ophthalmologist or an oculoplastic surgeon
is still primarily to protect the eye, to protect your vision, to protect the health
of your eyes.
I think that your surgeon being submissive may be just a challenge in communication skills,
maybe anticipating that this would likely resolve without any type of additional surgical
intervention.
So I think that for now, I generally tell my patients who come for a second opinion
like yourself that as long as your eyes are being properly lubricated and even if you
have to temporarily forgo wearing contact lenses.
Basically, you need to allow about 6 months to even a year to let the eyelids heal before
considering any additional revision surgery.
Now this is again in the absence of a physical examination but if you are able to manage
your dry eye symptoms and be proactive as well even if you don't have the symptoms to
continuously lubricate your eyes, I think you’ll be able to get through these next
few months without having to have any other intervention at this time.
So follow-up with your surgeon and of course, also work with your eye doctor in managing
the lubricating issue with the dry eye symptoms and the eye closure and hopefully, you’ll
be able to get through this without needing any additional surgery.
So I hope that was helpful, I wish you the best of luck and thank you for your question.