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What is the best surgical procedure for dry eyes after plugs and drops have failed?

One of the biggest things to become adjusted to in Colorado is the dryness. Along with the altitude and sunlight, the dryness of the air can contribute to dry eyes. When one is first diagnosed with dry eyes, the patient is usually instructed to use artificial tear drops or even prescription drops such as restasis.Initially, the drops are placed four times a day but can go up to almost every hour. The drops work to lubricate the eye surface. The prescription drops theoretically work by reducing inflammation in the tear gland allowing it to make more tears. In an area where dryness of the eye is caused primarily by the dryness of the air, it may not be the best treatment. Sometimes even both drops are given.

However, after those drops are found to be not working, often patients have punctal plugs placed. These plugs are used to block the tear duct so more water stays on the surface of the eye. Punctal plugs work quite well and are often an ophthalmologists go to treatment after drops are show to be not working. There are several procedures that can also augment dry eye treatment. As an oculoplastic surgeon in Denver, Colorado I often have patients who have failed drops or plug placement and are looking for other options. These are a list of a few things we have at our disposal.

  1. Permanent closure of the tear ducts

  2. Tarsorrhaphy

  3. Lower eyelid spacers to raise the lower eyelids

When patients have punctal plugs placed in their tear duct, they can often fall out and have to be routinely replaced. This can be cumbersome for the patient over time. A more permanent solution is permanent closure of the tear ducts. This procedure takes 15 to 20 minutes per eye and is a simple procedure that can be done. There are two tear duct holes per eye and often we close one permanently before closing both of them. This is a more permanent solution for dry eyes and punctal plug.

A tarsorhaphy is a procedure that is done to close the corners of the eyelids. By doing so, the eye aperture or space between the upper and lower eyelid is smaller. This creates less space for the water on the surface of the eye to evaporate. Tarsorraphy is usually done if closure of the eye tear ducts has not solved the problem.

The final procedure is elevating the lower eyelids to close the eyelid aperture or space between the upper and lower eyelid. This is done by placing the patients own tissue or synthetic tissue in the lower eyelids to elevate them. This is especially useful if the lower eyelids have dropped over time and causing the patients to have a great amount of dry eyes.

Hopefully, this gives patients in Colorado an opportunity to learn about surgical procedures for dry eyes once drops and plugs are not working.

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