Dry Eye Syndrome After Blepharoplasty: The Importance of Preoperative Ophthalmologic Assessment

Aims: To evaluate the incidence of dry eye syndrome after blepharoplasty and to determine the impact of preoperative ophthalmologic assessment and the baseline condition of the ocular surface on the development of postoperative tear film disturbances.
Material and methods. A retrospective single-center study was conducted including 215 periocular surgical procedures performed between January 1, 2020 and December 31, 2025. The mean age of the patients was 48.5±9.89 years (median 47 years; range 26–77 years); women – 187 (87.0%), men – 28 (13.0%). Patients were divided into groups depending on the extent of preoperative ophthalmologic assessment: no examination, examination without specific tear film tests, and examination including the Schirmer test and tear break-up time (TBUT) measurement. The incidence of postoperative ocular surface complications, including dry eye syndrome, was evaluated. Results. In the early postoperative period, dry eye syndrome was diagnosed in 55 patients (25.6%), while chemosis was observed in 58 patients (27.0%). The incidence of de novo dry eye syndrome was higher in patients who did not undergo preoperative ophthalmologic examination (8.6%) compared with those examined without specific tear film tests (5.6%) and those who underwent specialized tear film assessment (2.2%). However, no statistically significant association was found between the extent of preoperative ophthalmologic assessment and the incidence of de novo dry eye syndrome (p=0.3997). At the same time, the presence of preoperative dry eye syndrome showed a statistically significant association with its persistence after surgery (p<0.0001).
Conclusion. The preoperative condition of the ocular surface is an important risk factor for the development or persistence of dry eye syndrome after blepharoplasty. An insufficient scope of preoperative ophthalmologic examination, including the absence of objective assessment of tear production and tear film stability, may lead to underestimation of the risk of postoperative dry eye syndrome. Standardization of ophthalmologic examination in the preoperative and postoperative periods can improve detection of ocular surface disturbances and optimize prevention and management of patients.
Key words: Blepharoplasty; lower blepharoplasty; upper blepharoplasty; blepharochalasis; combined blepharoplasty; dry eye syndrome; tear film dysfunction; tear break-up time; Schirmer test; chemosis; preoperative ophthalmologic assessment
Conflict of interest. The authors declare no conflict of interest.
Financing. There was no funding for this study