IMPACT OF EYELID PLASTIC SURGERY ON TEAR FILM DYNAMICS AND THE OCULAR SURFACE

Abstract

Introduction: Eyelid plastic surgery, particularly upper and lower blepharoplasty, has been widely used to correct functional and aesthetic changes resulting from periocular aging. However, scientific studies have shown that these interventions can alter eyelid anatomy, tear distribution, and ocular surface stability. Changes in eyelid position, blinking mechanisms, orbicularis muscle function, and the contact between the eyelid margin and the eyeball have been associated with alterations in tear film dynamics, potentially leading to dry eye symptoms, tear instability, ocular surface inflammation, and changes in visual quality. Nevertheless, these effects vary depending on the surgical technique employed, the preservation of anatomical structures, and the patients' pre-existing ocular surface conditions. This study aims to analyze available scientific evidence regarding the impact of eyelid plastic surgery on tear film dynamics and the ocular surface, evaluating key changes related to tear stability, dry eye symptoms, and functional repercussions following the procedures. Methodology: A systematic literature review was conducted based on PRISMA checklist recommendations, utilizing scientific articles published over the last 10 years in the PubMed, SciELO, and Web of Science databases. The following descriptors were used: “Blepharoplasty,” “eyelid surgery,” “dry eye disease,” “tear film,” and “ocular surface.” Clinical studies, reviews, and research regarding the effects of eyelid surgery on the ocular surface, published in Portuguese or English, were included. Duplicate articles, studies unrelated to the topic, and publications without full-text access were excluded. Results: The analyzed studies demonstrated that eyelid surgery could cause transient or persistent alterations in ocular homeostasis, primarily due to a temporary reduction in blink frequency, altered tear distribution, and partial impairment of the eyelid's protective function. Lower blepharoplasty was associated with a higher risk of changes in eyelid position, whereas upper eyelid procedures could interfere with tear dynamics by altering the palpebral aperture and exposing the cornea. However, conservative techniques reduced complications by preserving eyelid anatomy and facilitating the recovery of tear film stability. Conclusion: Evidence indicated that eyelid plastic surgery could significantly influence tear film dynamics and ocular surface integrity, particularly in patients predisposed to dry eye disease. Thorough preoperative assessment and the use of tailored surgical techniques were crucial for minimizing tear-related changes and ensuring optimal functional and aesthetic outcomes. Studies underscored that preserving eyelid structures was essential for maintaining ocular stability and reducing postoperative complications.