Blepharoplasty in the post-laser in situ keratomileusis patient: preoperative considerations to avoid dry eye syndrome.

BACKGROUND The authors used a retrospective case series to describe the increased frequency of dry eye syndrome in patients who have undergone both laser in situ keratomileusis and blepharoplasty. METHODS The authors reviewed records from six patients who required surgical correction for exposure keratopathy previously treated by both laser in situ keratomileusis and blepharoplasty. RESULTS All six patients developed significant exposure keratopathy postoperatively requiring surgical intervention. Four patients had blepharoplasty followed by laser in situ keratomileusis, and two patients had laser in situ keratomileusis followed by blepharoplasty. Symptomatic dry eye symptoms followed the second procedure 1 week to 4 months later. Surgical correction of eyelid malposition and lagophthalmos markedly improved symptoms. CONCLUSIONS Patients with a history of laser in situ keratomileusis contemplating blepharoplasty are at higher risk of developing postoperative dry eye syndrome. Surgeons performing these procedures should perform thorough preoperative evaluation and surgical planning to minimize this potential complication.