There are three things that should be evaluated when a patient is having an eyelift. These three components are critical to the safety of the procedure. It is considered a deviation from a standard of care for blepharoplasty or eyelift if these three things are not checked before surgery.
I had a patient who had a blepharoplasty with dry eyes in Wyoming. The patient informed me that the screening of eye disease for the blepharoplasty or eyelift was the doctor asking them “how are your eyes” where she responded “good”. That is probably not the most scientific approach to determining if a patient is a good candidate from an eye health perspective to undergo a blepharoplasty or eyelift.
An eyelift or blepharoplasty is a procedure to remove skin and fat from the upper and or lower eyelid. When this procedure is performed for cosmetic purposes, there are many implications for the eye health. This is not something that should be glossed over lightly. Oculoplastic surgeons in Denver check the eye health before performing blepharoplasty. Non eyelift specialists usually have an ophthalmologist “clear the eyes” before the eyelift procedures. Below are the three most important criteria that should be looked at before blepharoplasty or eyelift.
Denver air is dry. It is a function of being in the high altitude. With that comes dryness to the eyes. Dry eyes are a problem for patients as they get older. The rate of dry eyes increases in post menopausal women. Women comprise over 75% of patients who undergo eyelifts or blepharoplasty. As a result there is a lot of crossover for the group of people who are undergoing blepharoplasty along with the group of people who have dry eyes.
By removing skin, the eyelid aperture can open. In other words, the eyes can be more open. As a result the evaporation of tears from the eye surface can increase making the eyes more dry.
There are a couple facts that are important to know when getting a blepharoplasty and understanding dry eye.
1. If you don’t have dry eye before blepharoplasty it is possible to have dry eye after blepharoplasty
2. If you have dry eye before blepharoplasty the dry eye can certainly get worse after blepharoplasty
3. Dry eye can cause deterioration in your vision.
4. Dry Eye can cause pain and discomfort
Dry eye is a serious issue to look at in any patient undergoing blepharoplasty or eyelifting. In Denver these risks are serious because of the environment. Most patients should be screen for dry eyes. This is done via two tests:
1. Slit lamp examination of fluorescein dye testing of the cornea
2. Slit lamp examination of Tear break up time of the cornea
3. Slit lamp examination to look at previous damage to the cornea from dryness
A slit lamp is a microscope that used to examine the eye surface. In patients undergoing blepharoplasty, a slit lamp exam is considered standard of care to screen out diseases.
Eyelid Closure Issues or Lagophthalmos
Removing skin from the eyelids can cause lagophthalmos or eyelid closure problems. There are several medical problems with the eyelids that may predispose a patient to having problems with eyelid closure before and after blepharoplasty. Any blepharoplasty reduces eyelid closure strength and most patients can handle it. That being said, there are several eye diseases that predispose to major problems closing the eye after blepharoplasty or eyelift.
Previous Bell’s Palsy
A Bells palsy is a condition where patients usually have trouble closing their eye on one side for 6 months. Most patients recover function of their eyelid closing but not all patients do. Patients with previous Bell’s palsy may also have an incomplete blink meaning their eyelids close but not at the same strength or power as a normal eyelid which was not affected by Bell’s palsy.
Any previous surgery is going to predispose a patient to eyelid closure issue. The eyelids may not close in the same way if surgery had not been done.
Patients can have eyelid closure issues that they are born with. These should be evaluated during the exam. Sometimes the patient will admit that they have trouble closing the eyes during sleep. A slit lamp exam of the patient will reveal dryness commonly.
Myasthenia Gravis is an autoimmune disease that causes problem with eyelid muscle function. Patients may have droopy eyelids but also problems with a muscle called the orbicularis which is involved in eyelid closure. A patient who has myasthenia gravis should undergo a blepharoplasty with caution. They are predisposed to eyelid closure issues after the procedure. There are several tests that are done to screen if a patient has myasthenia.
Fatigue of eyelids
Cogan’s lid twitch
A patient who undergoes blepharoplasty should be screened for myasthenia gravis using these tests. All my patients undergoing eyelift undergo testing in my Denver office for myasthenia gravis.
Numbness of Cornea (Hypesthesia of the Cornea)
Tear production is dependant on proper sensation of the cornea. As a result, when the eye is starting to feel dry, more tears are made to lubricate the eye. Numbness of the cornea predisposes the eye to a reduced tear production. When this happens, a blepharoplasty can cause severe dry eyes. There are two main causes of numbness of the cornea that should be screened for before eyelift or blepharoplasty.
Herpes or Chicken Pox in the eye
Previous herpes infection or chicken pox in the eye can create numbness of the cornea that should be screened for during an eyelift examination. Slit lamp exam may reveal corneal changes suggestive of previous herpes virus infection of the eye. This will alert the surgeon that this patient may not fare well from blepharoplasty.
Tumor or Previous Tumor
A Brain tumor or removal of a brain tumor can cause numbness of the eye or cornea. A history of brain tumor removal can alert a surgeon to corneal numbness. Corneal numbness itself can alert the eyelift surgeon that a patient may have a brain tumor that has not been caught yet. In any situation like this, blepharoplasty is not a good procedure for the patient.
These are the summary of what should be tested in the eye before a patient gets an eyelift or blepharoplasty. Every single patient in my office gets screened for these diseases prior to blepharoplasty. Eyelifting is serious surgery and eye diseases should be screened before the procedure is undertaken. Careful examination of the cornea is key for reduction in post operative complications. It is a requirement for the surgery in my opinion.