IMPACT OF ORBICULARIS OCULI MUSCLE STRIP EXCISION DURING UPPER LID BLEPHAROPLASTY ON TEAR FILM BREAK UP TIME AND POSTOPERATIVE DRY EYE SYMPTOMS

Abstract

Background: Dry eye syndrome (DES) is common after upper lid blepharoplasty (ULB), but tends to be self-limiting over the course of days to weeks. This occurs because the blink mechanism and tear film spread over the cornea are disrupted temporarily. More aggressive surgical techniques and over-excision of skin and orbicularis oculi muscle (OOM) appeared to increase the risk of dry eye following ULB. Objectives: to study the impact of OOM strip excision during ULB on the tear film break up time (TFBUT) and postoperative occurrence and severity of dry eye symptoms. Paitents and Methods: This interventional comparative study included 40 eyes of 20 patients (14 females and 6 males, the mean (M) age was 57.05 ± 4.80 years old. All patients had bilateral aesthetic ULB. Patients were divided into two groups: Group A: 8 patients (5 females and 3 males, M age was 58.38 ± 5.53 years old) who had bilateral ULB surgeries including OOM strip excision. And Group B: 12 patients (9 females and 3 males, M age was 56.17 ± 4.26 years old) who had bilateral ULB surgeries with preservation of OOM. Preoperative evaluation: General medical history and full ophthalmologic history were taken. Full ophthalmologic examination was performed including corneal and tear film examination, TFBUT and Schirmer's tests. Lid crease height, palpebral fissure and marginal reflex distance were measured. Patients with uncontrolled chronic systemic diseases were excluded. Patients with exophthalmos, lid retraction, ptosis, brow ptosis, entropion or ectropion were also excluded. Follow up: TFBUT and dry eye symptoms were assessed for each patient at one week and at one month postoperatively. Patients with continuous symptoms of dry eye postoperatively were followed up until three months. The changes of TFBUT of participants were statistically analyzed using the paired t-test. The M and standard deviation (SD) were used to obtain probability (P) value which was considered statistically significant when it was ≤ 0.05. Results: As regard changes of TFBUT; there was statistically significant decrease in TFBUT M values in group A from 11 ± 1.37 seconds (s) preoperatively to be 9.69 ± 2.18 s at one week postoperatively. This decrease in TFBUT M value was temporary and reversible as there was statistically significant increase of TFBUT M value from 9.69 ± 2.18 s at one week postoperatively to be 10.56 ± 1.86 s at one month postoperatively which was near to the preoperative value As regard group B, there were non-statistically significant changes in TFBUT M values. Dry eye symptoms had been recorded by four patients from group A (50%) and two patients from group B (16.7%). These symptoms were more severe in patients of group A. All these symptoms were reversible and frequent use of lubricating eye drops and gels for one week was enough to reduce the patients' discomfort in most of cases, but 2 female cases from group A with multiple combined risk factors had needed to use low dose steroid eye drops and night eye anti-inflammatory ointments in addition to relatively longer period of lubricating eye drops using to reduce dry eye symptoms. According to the present study results, the most important risk factor for postoperative dry eye symptoms was excision of OOM strip during ULB. History of lubricating eye drops using was also associated with increased incidence of postoperative dry eye symptoms. Hypothyroidism and diabetes mellitus (DM) were suspected risk factors which have needed to be proven by further specific studies. Changes of TFBUT and reported dry eye symptoms following ULB were temporary and reversible in all cases of the present study. Conclusion: Excision of OOM strip during ULB was associated with temporary statistically significant decrease in TFBUT and was also associated with more occurrences of reversible dry eye symptoms. Avoiding excision of OOM strip during ULB (if not indicated) was proven to minimize the occurrence of postoperative dry eye symptoms especially for patients with history of DES, for patient with repeated ULB, and those with systemic risk factors such as DM and thyroid dysfunctions.