ASSESSING THE IMPACT OF LEVATOR RESECTION BY ANTERIOR APPROACH WITH AND WITHOUT UPPER LID BLEPHAROPLASTY ON DRY EYE SYNDROME

Background: Dry eye disease is a multifactorial condition that significantly affects tear film homeostasis, resulting in ocular discomfort and surface damage. Surgical interventions like upper eyelid blepharoplasty, often performed for aesthetic and functional purposes, can disrupt the tear film, particularly when combined with levator resection. Understanding the impact of these procedures on dry eye parameters is crucial for optimizing patient outcomes, especially in populations predisposed to dry eye symptoms due to age or other risk factors. Objective: To evaluate and compare the effects of upper eyelid blepharoplasty with levator resection versus levator resection alone on dry eye parameters, focusing on tear film stability and subjective symptoms. Methods: This prospective study included 120 eyes from 120 patients diagnosed with acquired ptosis, equally divided into two groups: one undergoing upper eyelid blepharoplasty combined with levator resection and the other undergoing levator resection alone. Dry eye parameters, including tear break-up time (TBUT), Schirmer's test, and Ocular Surface Disease Index (OSDI) scores, were assessed preoperatively, and at 1 and 3 months postoperatively. The surgeries were performed under local anesthesia, and postoperative evaluations excluded the use of lubricants to ensure unbiased tear film assessments. Results: In the blepharoplasty with levator resection group, the mean preoperative TBUT decreased from 15.27 ± 2.62 seconds to 14.32 ± 2.89 seconds at 1 month, followed by partial recovery to 14.87 ± 2.72 seconds at 3 months. Schirmer’s test values dropped from 14.88 ± 2.12 mm preoperatively to 13.87 ± 2.29 mm at 1 month, improving to 14.60 ± 2.13 mm at 3 months. The OSDI score increased from 48.05 ± 19.12 preoperatively to 48.95 ± 19.24 at 1 month and improved to 46.55 ± 19.13 at 3 months. In contrast, the levator resection alone group showed stable dry eye parameters, with preoperative TBUT, Schirmer’s test, and OSDI scores remaining consistent at 1 and 3 months. Conclusion: Upper eyelid blepharoplasty with levator resection temporarily exacerbates dry eye symptoms and reduces tear film stability, with partial recovery by 3 months. Levator resection alone did not significantly impact dry eye parameters, underscoring the role of blepharoplasty-specific interventions in these changes. Proactive patient counseling and early postoperative management are essential for mitigating transient discomfort.