Effect of upper eyelid blepharoplasty surgery on cornea biomechanics and ocular surface.

Purpose: To evaluate the changes in corneal biomechanical properties and tear film layer analysis after upper eyelid blepharoplasty surgery.

Method: Sixty eyes of 30 patients were included in our prospective study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc) and Goldmann intraocular pressure (IOPg) measurements were taken with the Ocular Response Analyzer (ORA) device at the preoperative, postoperative 1st and 3rd months. The ocular surface was evaluated with tear breakup time (TBUT) and Ocular Surface Disease Index (OSDI) scores. Lid crease (LC), margin-to-reflex distance 1 (MRD1), and palpebral fissure height (PFH) were evaluated at each visit.

Results: In the ORA analysis, in the 1st month CH value was found to be significantly lower than the preoperative value (preoperative 13.39 ± 6.08 mmHg; 1st month 10.74 ± 1.94 mmHg, p = 0.011). In addition, there was a statistically significant decrease in the 3rd month value compared to the preoperative values (10.46 ± 1.69 mmHg, p = 0.021). However CRF decreased postoperatively, no statistical difference was detected (preop 12.59 ± 3.84; 1st month 11.94 ± 3.04; 3rd month 9.78 ± 1.74; p = 0.149). While there was a decrease in IOPcc and IOPg in the postoperative period, no statistical difference was detected (respectively p = 0.96, p = 0.71). In the postoperative 1st month, TBUT increased significantly (p = 0.024). When those with a TBUT value below 10 were considered dry eye, significant decrease was observed in the percentage of dry eye in the first postoperative month (p = 0.027). Although the dry eye percentage decreased in the 3rd month compared to the preoperative percentage, no statistical difference was detected (p = 0.125). There was a significant decrease in the number of those with an OSDI score above 13 in the first month (p = 0.004).

Conclusion: In our study, a decrease in ORA values was observed after blepharoplasty, with only CH being statistically significant. Reducing the load on the cornea after surgery may change the corneal biomechanics. These changes should be taken into consideration after eyelid surgery, especially in patients who may require glaucoma follow-ups.