Evaluation of Ocular Surface Changes Induced by Eyelid Surgeries 

Abstract

Background: Dry eye disease (DED) is a common multifactorial disorder of the tear film and ocular surface. This work aimed to evaluate the early and late effects of different eye lid surgical interventions on ocular surface and corneal topography as understanding these interactions is crucial before performing eyelid surgeries and during follow up. Methods: This prospective interventional comparative study included 60 eyes of patients with eyelid abnormalities recruited from Tanta University Hospital. Patients were equally divided into three groups according to the surgical procedure performed. Group I underwent upper eyelid blepharoplasty with skin excision combined with transconjunctival lower eyelid blepharoplasty with fat removal. Group II underwent transcutaneous levator surgery. Group III underwent upper eyelid transcutaneous tarsal fracture or lower eyelid retractor plication. All participants underwent comprehensive preoperative ophthalmic evaluation. Postoperative assessments of ocular surface parameters and refractive changes were conducted at 1, 3, and 6 months following surgery and compared with baseline preoperative values. Results: In Groups I and II, OSDI scores were significantly higher at 1 month postoperatively compared with baseline but returned to baseline levels at 3 and 6 months. Schirmer I test and tear meniscus height showed no significant changes throughout follow-up. NIBUT was significantly reduced at 1 month postoperatively, with no significant differences at 3 and 6 months. Lipid layer thickness was significantly increased at all postoperative visits, while ocular surface staining increased at 1 month and improved by 6 months. No significant postoperative changes were observed in upper or lower lid meibomian gland loss. In Group III, OSDI scores significantly improved at all postoperative follow-ups compared with baseline. Schirmer I test and tear meniscus height were significantly reduced, whereas NIBUT and lipid layer thickness were significantly increased at 1, 3, and 6 months postoperatively. Upper lid meibomian gland loss showed a significant increase over time, while no significant changes were observed in the lower lid. Corneal topographic parameters showed no significant changes across all study groups during follow-up. Conclusions: Eye lid surgeries may induce transient changes in both subjective and objective tear film parameters. Importantly, these changes are largely reversible, as most parameters return to baseline or near-baseline levels by six months post-surgery. Surgical correction of entropion results in healing of superficial keratopathy and improves tear film stability contributing to improve the vision.