Dry Eyes After Blepharoplasty: How Common, Why and When It Settles

Dry eyes after blepharoplasty are a common complaint. In a ten-year series of 892 operations, about a quarter of patients reported dry eye symptoms, and a similar proportion developed swelling of the thin membrane covering the white of the eye (chemosis).³ Yet a pooled analysis of randomised trials looking only at upper eyelid surgery found that dry eye symptoms were lower after surgery than before it.⁴

The two findings do not contradict each other. The risk depends on which eyelid is operated on, the technique used and the state of your eyes before surgery.^3,5 Below we explain why dryness happens, who is at higher risk, what is checked before surgery and which symptoms are no longer normal.

How common are dry eyes after blepharoplasty?

One of the most quoted sources is a retrospective review of 892 upper and lower eyelid operations performed by a single surgeon over ten years. Dry eye symptoms were reported in 26.5% and chemosis in 26.3%.³ It was retrospective and single-centre, symptoms came from a questionnaire completed by patients, and it included lower eyelid surgery.

Higher-quality data paint a different picture. A meta-analysis of 12 randomised trials with 450 patients found a significant reduction in dry eye symptoms after upper blepharoplasty compared with before surgery.⁴ In other words, upper eyelid surgery does not dry out everyone’s eyes, and some people feel better. The analysis covered upper eyelid surgery only, however, so its results may not apply in the same way to lower eyelid surgery or to people who already have dry eye.

Why does it happen?

Temporary incomplete eyelid closure (lagophthalmos) is commonly seen after blepharoplasty and leaves more of the eye surface exposed; when it is caused by swelling, it usually resolves within seven days.² In the 892-case series, dry eye symptoms were significantly more frequent in patients with temporary lagophthalmos after surgery, and the authors noted that approaches through the skin that disrupt the ring muscle around the eye (orbicularis oculi) may increase the risk.³

Surgery itself may also trigger a temporary inflammatory response in the tears. In a small study of 20 patients, inflammatory markers in the tears rose after upper blepharoplasty and the tear film broke up faster. In people without previous dry eye this shortening was seen only at one month, while in those with dry eye it persisted for six months.⁵

Who is at higher risk?

Most of the factors that raise the risk can be identified before surgery. The main form of prevention is therefore operating on the right person, with the right technique, at the right time.

Contact lenses are not in the table but come up often. Lens wearers avoid lenses for about two weeks after surgery.¹ If you have worn lenses for many years and your eyes already feel dry, mention it at the first consultation.

What is checked before surgery?

Mayo Clinic notes that before eyelid surgery you are asked about dry eyes, glaucoma, allergies, circulation problems, thyroid problems and diabetes.¹ In Op. Dr. Esin Özlem Atmış’s planning, tear production and visual fields are also tested and eyelid closure is assessed; if you have dry eye, it is treated before surgery and taken into account in the plan. Upper eyelid skin is removed conservatively and the tone of the lower lid is tested first. These checks are described on our eyelid surgery page.

For people at higher risk the plan can change: less skin may be removed, the muscle may be preserved, upper and lower lids may be treated in separate sessions, or surgery may wait until the dryness is under control. In randomised trials, muscle-sparing techniques reduced incomplete eyelid closure.⁴

How is dryness managed during recovery?

Using the drops and ointments your surgeon gives you regularly is the basic step in the first weeks.¹ When the eye surface is exposed, standard treatment is frequent artificial tears with a lubricating ointment at night; the eyelids can be taped, and a moisture chamber (a protective cover around the eye) or tear duct plugs can be used if needed.²

In a small study, people who already had dry eye before surgery had more symptoms at one month, which returned to pre-surgery levels by six months.⁵ In the meantime, avoiding long unbroken spells at a screen, protecting the eyes from wind and sun, and not rubbing them make things easier. For the day-by-day recovery timeline, see our guide to blepharoplasty recovery day by day.

When is it not normal?

Grittiness, watering and temporary blurring are expected in the first days. EyeWiki notes that incomplete eyelid closure is commonly seen after blepharoplasty, and that when the eye stays open during sleep, symptoms can be worse in the morning.² Prolonged exposure of the eye surface can lead to corneal abrasion, ulceration and infection, and in severe cases to permanent loss of vision.²

Contact your surgeon without waiting if:

• You still cannot close your eye fully once the swelling has gone down
• Burning, grittiness or a foreign-body feeling is getting worse, especially in the mornings²
• Redness and pain are increasing despite drops and ointment
• You have severe new eye pain or a change in vision¹

When lagophthalmos persists, surgery to treat the underlying cause may be needed.² In the early phase, treatment usually starts with drops, ointment at night and close follow-up.²

Frequently asked questions