Q : I had my lower eyelids tucked (blepharoplasty) over 6 months ago. While my lower lids look much better, I have had a problem with dry eyes and tearing since the surgery. It was really bad right after and has gotten somewhat better. It is almost painful to be out in direct sunlight and my eyes really tear if there is any wind. My lower eyelid also doesn’t look right. I think I show more whites of the eye than before and it looks pulled down. My doctor keeps saying to give it more time and it will get better. But it has been some time now since surgery and I just don’t see it happening. What do you suggest? By the way I am a women who is 58 and I still have to work!
A: One of the potential, although fortunately uncommon, risks of lower blepharoplasty surgery is ectropion. This sounds like exactly what you have.
The lower eyelid, unlike the upper, is like a clothesline strung out between the inner and outer eye socket bones. The eyelid is attached to the bone by tendons called the canthal tendons. This clothesline effect keeps the lower eyelid snugged up against the eyeball just at the lower edge of the iris. By being tight up against the eyeball, it is protected from drying out and being irritated. Any slight change, even one millimeter, between the eyelid and the eyeball (out or down) will cause eye symptoms of dryness, irritation, and tearing. Manipulation of the lower eyelid through surgery can disrupt this relationship if the eyelid and the lateral canthal tendon are snugged back up properly as part of the operation.
While small amounts of ectropion may correct itself with the passage of time and upward massage, six months with this degree of symptoms indicates another approach is necessary. Performing a canthopexy or canthoplasty (tendon tightening and eyelid re-suspension) and retightening of the outside eye corner can provide an immediate solution to this very irritating problem. Once the lower eyelid is back tight against the eyeball, it will not only look better and more natural but the eye is protected once again.
Dr. Barry Eppley