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Eyelid Closure Problems after Cosmetic Eyelid Surgery

What happens if you can’t close your eye after eyelid surgery: A Denver eyelid specialist explains

Blepharoplasty or cosmetic eyelid surgery is a procedure to improve the appearance of the eyelids by either removing, repositioning or sculpting fat and skin around the eyelids. One of the complications of eyelid surgery is an inability to close the eyes. This article is an in depth explanation of eyelid closure, when it happens, the course of how long it is, what problems it may cause and how it is treated in the short term and long term.

So first of what are the causes of eyelid closure problems after blepharoplasty or cosmetic eyelid surgery. There are many contributing factors for eyelid closure problems in the short term and long term. They are

  1. Numbing medicine

  2. Skin tightness

  3. Deeper tissue scarring

  4. Nerve damage

Numbing Medicine

Immediately after surgery the eyelid muscles that are used to close the eye are often stunned from the numbing medicine. Over a one week period, the numbing medicine usually completely wears off and eyelid closure improves.

Skin tightness

During blepharoplasty, often the eyelid skin is removed or tightened. When the skin is removed the eyelids can feel tight and often the eyelids do not close fully for the first month after this. If a patient has this it tends to get better. Even after a month, with time (usually 6 months to a year) the eyelid closure improves and returns to normal. The eyelid skin usually stretches and eyelid closure improves.

Deeper Tissue scarring

Additionally during blepharoplasty or cosmetic eyelid surgery, the deeper tissues of the eyelids are manipulated. Sometimes as the deeper tissues heal, scar tissue forms which tethers the eyelid and prevents it from closing. The technical term for this deeper tissue is the orbital septum. Patients who experience this often do not have eyelid closure problems initially but as the scarring develops, the eyelid closure issues may develop.

Nerve Damage

Finally, a rare cause of eyelid closure problems after blepharoplasty is nerve damage. There are nerves that travel in the corners of the eye that supply the muscles that control eyelid closure. If those nerves are damaged the eyelid closure muscles don’t work well and the eyelids have trouble closing. If there is nerve damage after cosmetic eyelid surgery, the nerves can often regenerate. I would give it 6 months to see if the nerves can regenerate completely.

Remember if yourself or someone has problems closing the eyes after cosmetic eyelid surgery, the cause can be a combination of these causes. An oculoplastic surgeon can determine which of the causes are playing a role in your particular case.

So what are the problems associated with eyelid closure? First off, eyelid closure problems can result in dryness of the eye. This can cause foreign body sensation (feeling something in the eye), blurry vision or even discomfort of the eyes. If the eye drys out the cornea can be damaged and vision can be damaged as well. Often if eyelid closure is small, patients can even have no symptoms or be completely unaware.

The treatment for eyelid closure problems are often supportive therapy initially. Supportive therapy means things that improve the symptoms while you are waiting for things to heal.

This often involves lubricating the eyes with artificial tear drops and ointment. Often at night ointment needs to be placed in the eye because eyelid closure can be troublesome while the patient is sleeping. In other cases, the eyelids can be temporarily closed or tear plugs placed to help the eyes stay more moist. Often we ask patients to massage their eyelids to help stretch tissue and help things relax.

After six months to a year if there are still eyelid closure problems, things can be done surgically to help the eyelids close. This can involve skin grafts, placing gold weights in the eyelids, placing stitches in the corner of the eyelids. Each treatment is dependant on the individual patient, their cause of eyelid closure problems and their individual tissue. The best route is to see an eyelid specialist who can evaluate your eyelids and determine the problem and potential treatments. If you are having eyelid closure problems associated with or without cosmetic eyelid surgery it is best to see an eyelid specialist.

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