The Association of Blepharoplasty and Ptosis Repair Surgeries with the Development of Postoperative Dry Eye Syndrome (DES)

Background Dry Eye Syndrome (DES) poses a significant ocular health concern globally, leading to pain and visual changes that may persist for several years. This study investigates the incidence and risk factors associated with DES following four different upper eyelid surgeries: Muller's Muscle-Conjunctival Resection (MMCR), internal levator advancement and resection (internal LAR), external levator advancement and resection (external LAR), and Upper-Eyelid Blepharoplasty (UEB). Considering that these surgeries can affect the orbicularis muscle and lacrimal glands, we hypothesized that patients undergoing any of these surgeries could face an increased risk of developing DES post-operation.

Methods Analyzing the TriNetX patient health database for surgeries conducted between 2003 and 2023, records of 4,551 patients undergoing MMCR, 4,534 patients undergoing internal LAR, 15,326 patients undergoing external LAR, and 27,696 patients undergoing UEB were examined after application of exclusion criteria. Exclusion criteria included ICD-10 codes for pre-existing DES, Meibomian gland dysfunction, Sjogren syndrome, pterygium, thyroid disease, and diabetes. Analysis encompassed linear regression to identify demographic and medical risk factors associated with post-surgical DES. Propensity score matching (PSM) facilitated pairwise outcome comparisons between the four surgeries.

Results Internal LAR (OR: 1.17, 95% CI: (1.057,1.296)) and external LAR ((OR: 1.07, 95% CI: (1.008,1.128)) were strongly associated with the development of postoperative DES. Post-PSM pairwise comparison analysis showed that internal LAR carried a greater risk than external LAR (RR = 1.18; 95% CI: (1.062,1.303)). UEB was strongly associated with a decreased risk of postoperative DES ((OR: 0.89, 95% CI: (0.852,0.924)), while MMCR was not significantly associated with postoperative DES (OR: 1.04, 95% CI: (0.939,1.154)). Among all four surgeries, common risk factors for postoperative DES included osteoarthritis (OA), nicotine dependence (ND), obstructive sleep apnea (OSA), and female gender, while Asian ethnicity was a risk factor only for post-UEB DES.

Conclusion Internal LAR and external LAR present increased risk for postoperative DES, with OA, ND, OSA, and female gender significantly influencing DES incidence. Notably, internal LAR presents a heightened risk compared to external LAR. These results can offer valuable insights for patients and healthcare providers deliberating on various ptosis repair procedures, emphasizing the critical need for thorough preoperative evaluations and tailored patient education to mitigate the risk of DES in eyelid surgical interventions.