Pupillary and Anterior Chamber Changes Following Upper Eyelid Blepharoplasty

Evaluation of early period changes in intraocular pressure, ocular biometry and anterior segment after upper eyelid blepharoplasty

PURPOSE

To investigate the acute effects of upper eyelid blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters.

METHOD

This prospective cross sectional study examined the eyes of 49 patients with dermatochalasis. Following a detailed ophthalmological examination, corneal topography was used to evaluate the eyes mesopic and photopic pupil diameter, anterior chamber depth, and corneal astigmatism on the day of surgery and on days first and seventh postoperatively. Ocular biometry was used to assess axial length and intraocular lens power. Goldmann applanation tonometry was used to measure intraocular pressure.

RESULTS

Forty-nine eyes (26 males and 23 females) of 49 patients aged between 44 and 76 years (mean 61 ± 7.9) were included in our study. The mean anterior chamber depth (ACD) was 2.90 ± 0.37 mm preoperatively, 3.00 ± 0.29 mm at postoperative day first, and 3.04 ± 0.29 mm at postoperative day seventh, and the increase in anterior chamber depth was statistically significant (p < 0.001). The mean astigmatism values were measured as preoperative 0.73 ± 0.69 D, postoperative first day 0.93 ± 0.81 D, and postoperative seventh day 1.26 ± 0.90 D. The increase in astigmatism values was statistically significant (p < 0.001). The mean pupil diameter measurements in the mesopic environment were 4.20 ± 0.61 mm preoperatively, 4.40 ± 0.59 mm on the first postoperative day, and 4.39 ± 0.57 mm on the seventh postoperative day, and there was a statistically significant difference between the three measurements (p = 0.03). The mean IOP measurements of the patients were 15.91 ± 3.51 mmHg preoperatively, 16.81 ± 3.36 mmHg on the first postoperative day, and 16.97 ± 3.13 mmHg on the seventh postoperative day. The increase between these three measurements was statistically significant (p = 0.013).

CONCLUSION

This study includes important insights into the potential acute phase impact of blepharoplasty surgery on ocular findings. Patients undergoing upper eyelid surgery should be informed about the possible change in ocular biometric parameters, intraocular pressure, and pupil diameter.

Evaluation of the effect of eyelid disorder surgeries on tears and anterior segment parameters with meibography and corneal topography

Background/Aim: Abnormalities of eyelid shape, including ptosis, entropion, ectropion, lagophthalmos, and dermatochalasis, can occur at any age and affects the patient’s life quality, visual functions, and comfort. These abnormalities can be regarded as illnesses and can be cured medically and surgically. Meibomian glands are large sebaceous glands located in the lower and upper eyelids. Our study aimed to observe changes in anterior cornea segment parameters and meibomian glands of patients undergoing surgery for eyelid shape abnormalities. Methods: Our sample comprised 31 patients, who were operated on at Afyonkarahisar Health Sciences University Hospital, were examined with respect to cornea topographic measurements and the drop-out of meibomian glands at the pre-operative and first-month post-operative processes and post-operative third month. In this prospective cohort method study, the surgical eyes of the patients were determined as the study group and the healthy eyes as the control group. Results: Surgical and healthy eyes of 31 patients were included in this study (N=62). The sample comprised 18 male and 13 female patients. The average age and standard deviation values of patients were determined as 66.50 (17.315) in males and 65.92 (13.714) (P = 0.659) in females. In terms of anterior cornea segment parameters (K1, K2, ACA, ACD, ACV, and CCT), no prominent differences were found in pre-operative and post-operative results (K1, K2, ACA, ACD, ACV, and CCT) in both the study and control groups. Meibography revealed that the increased meibomian gland drop-out of surgical eye measurements of pre- and post-operative was statistically significant (P < 0.001), whereas the change seen in healthy eyes was not statistically significant (P = 0.051). Furthermore, although the change through meibomian glands of entropion patients was not significant (P = 0.066), the drop-out of the meibomian gland of the other surgery cases (ptosis, ectropion, lagophthalmos, blepharoplasty, and dermatochalasis surgery) was found to be statistically significant (P = 0.038). Conclusion: Surgeries to correct abnormalities in eyelid shape can lead patients to meibomian gland drop-out. Pre-operative assessment of patients whose surgeries are planned, and post-operative monitoring, must be done meticulously in order to minimize the likelihood of symptoms and avoid meibomian gland dysfunction.

Changes in Intraocular Pressure and Ocular Biometry After Blepharoplasty

PURPOSE

To investigate the effects of blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters.

METHODS

A total of 112 eyelids of 56 patients undergoing bilateral blepharoplasty due to upper eyelid dermatochalasis was included. The patients were classified into three groups according to margin reflex distance (MRD) (Group 1 >4 mm MRD, Group 2 2-4 mm MRD, and Group 3 <2 mm MRD). The IOP and ocular biometric parameters obtained baseline and postoperative 3^rd month were compared.

RESULTS

The demographic characteristics of the groups were similar (p > 0.05, for all). IOP (p = 0.002) and central corneal thickness (p = 0.038) increased in Group 3. The mean amount of the increase in IOP was 0.95mmHg. The keratometric values increased in all groups and corneal astigmatism was also increased in Group 2 and Group 3 (p < 0.001, for all). The mean amount of the increase in corneal astigmatism was 0.54D in Group 3. Anterior chamber depth and axial length did not change (p > 0.05, for all). The intraocular lens powers calculated by six different formulas decreased in Group 3 (p < 0.001, for all), and the mean amount of the decrease was 0.40D.

CONCLUSIONS

Clinicians should be aware of the potential change in IOP and ocular biometric parameters in patients who underwent blepharoplasty. If a patient has glaucoma risk factors, close follow-up is needed after blepharoplasty. Change in strategy or timing may also be needed for dermatochalasis patients when planning corneal refractive surgery or cataract surgery.

LEVEL OF EVIDENCE IV

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