Risk factors for the development of conjunctival chemosis and dry eye syndrome following lower eyelid blepharoplasty
Author: Parinaz Shams
Base Hospital / Institution: Moorfields Eye Hospital
ePoster presentation
Abstract ID: 24-412
Purpose
To determine risk factors associated with development of severe conjunctival chemosis and dry eye symptoms (DES) following lower eyelid blepharoplasty (LEB), such as pre-existing ocular disorders & concomitant upper eyelid or lateral canthal surgery and whether prophylactic treatments influence the incidence of these complications.
Methods
A retrospective medical record review of consecutive cases of LEB during a 5-year period. Patients with less than 3 months of postoperative follow-up, severe dry eye/ Sjögren syndrome and pre-excising chronic conjunctival chemosis were excluded from the study.
Results
A total of 80 cases met the study inclusion criteria. The average age was 59 years and follow-up of 8 months. Chemosis following LEB was noted in 47.5% of all patients and DES requiring > 2 months of intensive lubricating drops occurred in 36% of which 14% needed additional dry eye treatment (ADET) such as topical steroids or cyclosporin +/- punctal plugs. 35% had pre-operative DES of which 54% required >two months of intensive lubricating drops and 32% required ADET versus 27% & 4% respectively of those without DES. The incidences of DES and chemosis were significantly higher in patients who did not receive routine post-op topical steroids, the transcutaneous versus transconjunctival approach, concurrent upper eyelid blepharoplasty +/- ptosis repair, lateral canthopexy/plasty (P < .001), female gender, preoperative DES and history of refractive surgery (P < .05). Conjunctival chemosis was treated with topical steroids & intensive lubrication, 10% needed conjuntivotomy and in all cases resolved within 3 months.
Conclusion
Conjunctival chemosis & DES are common complications of LEB, resulting from ocular surface dryness and inflammation exacerbated by disrupted eyelid closure mechanics and lymphatic drainage. The routine use of topical steroids, intensive lubrication and temporary lateral tarsorrhaphy may reduce the incidence of post-operative chemosis in high-risk patients. Anatomical and pathophysiological causative factors and treatments to minimize and manage these complications are discussed.
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