Dynamic changes in tear film parameters after upper eyelid blepharoplasty measured with anterior segment optical coherence tomography

Background: Upper eyelid blepharoplasty, a corrective procedure for dermatochalasis, may transiently affect eyelid function and tear film stability. This study assessed the effect of upper eyelid blepharoplasty, subjectively through questionnaires, and objectively through tear film stability and production. Methods: This non-randomized, prospective, interventional study consecutively recruited the right eyes of patients with dermatochalasis who underwent bilateral upper eyelid blepharoplasty at a tertiary center. Preoperative assessments included a standardized ophthalmic examination, ocular surface disease index (OSDI) questionnaire, Schirmer’s test I, tear break-up time (TBUT) test, and anterior segment optical coherence tomography (AS-OCT) to measure tear meniscus height (TMH) and tear meniscus area (TMA). Postoperative evaluations were conducted at 1, 3, and 6 months. At the final follow-up, scar quality and patient satisfaction were assessed using the Patient and Observer Scar Assessment Scale. Results: Fifty eyes of 50 patients with a mean (standard deviation) age of 47.1 (1.6) years were included. Statistically significant postoperative changes were observed in the OSDI score, Schirmer’s test value, TBUT, and TMH at the 6-month follow-up (all P < 0.001). These parameters initially worsened at 1 month and then improved significantly at 3 and 6 months, returning to or surpassing baseline levels. TMA showed a transient postoperative decline, with full recovery at 6 months. Exceptionally strong positive correlations were found between TMH or TMA and TBUT or the Schirmer’s test value at most follow-up visits (all P > 0.05). Patient satisfaction was high, with 95% reporting satisfaction with cosmetic outcomes, and no cases of visible or hypertrophic scarring were observed at final follow-up. Conclusions: We observed significant yet transient changes in tear film parameters and subjective assessments following upper eyelid blepharoplasty. A strong correlation was observed between AS-OCT measurements and parameters of tear film stability and production. High patient satisfaction and favorable cosmetic outcomes, with no visible scarring, further support the safety and tolerability of this procedure. Further studies with larger cohorts, longer follow-up periods, and comparative designs are warranted to validate these findings and further explore the long-term effects on ocular surface health and patient-reported outcomes.