title: Optimizing blepharoplasty outcomes in patients with previous laser vision correction.
abstract: BACKGROUND
  Dry eye syndrome, often referred to as dysfunctional tear syndrome, can occur following laser vision correction surgery and routine blepharoplasty. Identifying patients prone to developing or worsening of dysfunctional tear syndrome following blepharoplasty can help optimize surgical outcomes.
  
  
  METHODS
  The authors highlight the salient features of the dysfunctional tear syndrome including key steps in identifying at-risk patients. The authors discuss changes in the cornea that occur with keratorefractive surgery and their significance in patients seeking blepharoplasty. The authors suggest guidelines for blepharoplasty in these patients and discuss the timing of surgery.
  
  
  RESULTS
  After blepharoplasty, lagophthalmos of the upper lid is a common temporary finding. This change in eyelid function may unmask underlying deficiencies in the tear film or corneal sensation. Coexisting lower lid malposition can displace the existing tear meniscus and increase exposure of the cornea. Whether in combination or alone, these findings can create a dry eye problem. Dysfunctional tear syndrome should be considered in all patients with a history of laser vision correction during the preoperative evaluation for blepharoplasty. Surgeons should rely on preoperative history and physical examination, including assessment of preoperative eyelid anatomy and the status of the ocular surface. Patients with prior laser vision correction should wait at least 6 months before undergoing blepharoplasty because of the effects on corneal sensation, tear production, and tear film alteration.
  
  
  CONCLUSIONS
  Identification and appropriate treatment of dysfunctional tear syndrome together with intraoperative modifications will optimize postoperative outcomes and avoid a potentially disabling condition after blepharoplasty in patients with previous laser vision correction surgery.
authors.affiliation: Atlanta, Ga.; and New York, N.Y. From Eye Consultants of Atlanta, Cornea, External Disease & Refractive Surgery Section, Paces Plastic Surgery, and Cornell-Weill Medical College/New York-Presbyterian Hospital, Plastic Surgery.
authors.forename: W Barry
authors.initials: WB
authors.lastname: Lee
authors.forename: Clinton D
authors.initials: CD
authors.lastname: McCord
authors.forename: Naveen
authors.initials: N
authors.lastname: Somia
authors.forename: Haideh
authors.initials: H
authors.lastname: Hirmand
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage; D019882:Blepharoplasty / Q000009:adverse effects*; D048988:Corneal Surgery, Laser / Q000009:adverse effects*; D016572:Cyclosporine / Q000008:administration & dosage; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D054327:Lubricants; D009883:Ophthalmic Solutions; D010348:Patient Care Team; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D012017:Referral and Consultation; D012307:Risk Factors
chemical_list: D018501:Antirheumatic Agents; D054327:Lubricants; D009883:Ophthalmic Solutions; D016572:Cyclosporine