Tear replacement therapy early after eyelid reconstructive surgery

Objective. To evaluate the effectiveness of moisturizing ophthalmic solution with sodium hyaluronate and sodium heparin and lubricant ophthalmic agent with sodium heparin early after eyelid reconstruction. Material and methods. We analyzed 40 patients (50 eyes) aged 18—75 years (median age 58.46±7.31 years) including 11 (22%) eyes in males and 39 (78%) eyes in females. Of these, 28 patients had upper eyelid ptosis (with bilateral ptosis in 20 cases and concomitant blepharochalasis in 18 cases), 8 patients had eyelid inversion and 4 patients had eyelid eversion. All patients underwent eye reconstructions. Correction of upper eyelid ptosis depended on its type: levator aponeurosis repair — 18 procedures (on both eyes, simultaneous resection of blepharochalasis); levator shortening — 4 procedures, suspension to the eyebrow — 4 procedures (both eyes in two patients); tarsomyectomy — 2 procedures, correction of eyelid inversion — 8 procedures, correction of eyelid eversion — 4 procedures. Postoperative management included instillations of antiseptics and antibiotics. Tear replacement therapy implied instillations of moisturizing ophthalmic solution with sodium hyaluronate and sodium heparin 3 times a day and ophthalmic ointment with sodium heparin at night for a month. All patients underwent standard ophthalmological examination before surgery, 2 weeks, 1 and 3 months later. We analyzed effectiveness of treatment considering eyelid skin status according to the Manchester Scar Scale, microscopy of the conjunctiva and cornea including staining with fluorescein, the Norn test. Results. Therapy improved the state of eye surface tissues in all cases (cornea, conjunctiva) without significant complications. Conclusion. The proposed combination of drugs improves the state of eyelid skin, contributes to wound healing without excessive scarring, fast regression of swelling of conjunctiva and eyelids, prevention of corneal erosions, stability of tear film and minimal edema of corneal epithelium.