Eyelid surgery is one of the most frequently performed surgical interventions in aesthetic surgery. Patients want to eliminate age-related changes, which primarily appear on the delicate skin of the eyelids. But any surgical intervention is a risk that can always lead to the development of complications. Dry eye syndrome is one of the most common complications occurring after blepharoplasty. The name of the syndrome speaks for itself: after surgery, the patient may be disrupted in the process of tear secretion, which is necessary for a very important physiological process - moisturizing the eyeball.
Dry eye syndrome in ophthalmology is usually called keratoconjunctivitis sicca. This disease can develop as a complication after manipulations in the eye area, as well as as an independent pathology. The etiological factors of keratoconjunctivitis sicca may be prolonged use of medications that regulate intraocular pressure, prolonged work at the computer, innervation disorders as a result of trigeminal nerve paresis, and other reasons. Mostly women over 40 years of age are susceptible to the disease. Dry eye syndrome manifests itself as a decrease and even complete cessation of tear secretion, as well as atrophy of the lacrimal glands.
Dry eye syndrome:
In the clinical picture of dry eye syndrome, there are 4 stages of the disease:
If a patient who has undergone blepharoplasty or other aesthetic surgery in the eye area shows signs of “dry eye” syndrome, he must consult an ophthalmologist. The diagnostic process of dry eye syndrome begins with a detailed medical history and a standard examination of the organ of vision with targeted biomicroscopy of the edges of the eyelids, conjunctiva and cornea. Additional research methods are:
Treatment of dry eye syndrome is symptomatic. Such patients are prescribed gel or water-based drugs, which are tear substitutes:
If artificial tear preparations do not achieve the desired effect, lacrimal canaliculus obturators are used. Additionally, patients with dry eye syndrome are recommended to take antibacterial and anti-inflammatory drugs, the prescription of which is necessary to prevent the addition of a secondary infection. In especially severe cases, surgical treatment is necessary, which consists of applying a special bio-coating to the surface of the eyeball.
Igor Aznauryan
Ophthalmologist, academician of the Academy of Medical Sciences, Doctor of Medical Sciences. Chief physician of the Yasny Vzor network of eye clinics.
Modern ophthalmologists have found out Computer Vision Syndrome who most often suffer from dry eye syndrome. These are those who spend a lot of time in front of gadget screens.
Many may not even be aware of their diagnosis. We will tell you the symptoms:
Doctors test dry eyes in another way - the Schirmer test. This is an examination that shows the amount of tears. Special pieces of paper are inserted under the eyelids to absorb tears. It is painless, takes a minute and gives an accurate result.
Before discussing the direct causes of dry eyes, let's figure out what it should be like normally. Fully moisturized - the tear that constantly washes the eye is responsible for this. And here there is an important nuance - the quality of the tears.
Yes, and tears can be of high quality, and sometimes not so good. There are two components in tears: water and fat (lipid). The balance of these components is a quality tear. If the balance is disturbed, dry eyes occur.
Now let's look at the reasons for this condition.
We mean any screen - computer, tablet or phone. If you look at any eye for too long, your eye begins to dry out. The fact is that bright light makes us concentrate and look more closely. We are too involved, and our eyes simply “forget” to blink. The fact is that blinking is an unconditioned reflex; we don’t think about it. And this reflex slows down when our attention is excessively focused on something.
We have dry air everywhere. Batteries work in the office and at home in winter, and in summer. And on the street: just remember what it’s like to walk in the heat - your throat gets dry, not to mention your eyes.
Dry air dries up the tears that should wash the eye. And it is even more dangerous than a computer screen.
Few people know that our cornea (this is the transparent outer shell of the eye) does not have blood vessels, that is, it is nourished by tears. For example, a tear must deliver oxygen to it. How will she do this if she dries out under the influence of dry air? The less oxygen and nutrients the cornea receives, the worse its condition.
This reason is purely female. During menopause, which can begin at a fairly early age, the amount of estrogen in a woman’s body decreases. These hormones affect fat metabolism. They also reduce the amount of fatty components of tears. This means that the consistency of the tear changes, it becomes more liquid and cannot stay on the eye. In such cases, women may experience causeless lacrimation.
Even if you remember to take them off at night, if you change them every day and are sure that your containers are sterile, you still cannot avoid dry eyes.
Wearing lenses for a long time = dry eye syndrome. This is an axiom. Lenses disrupt the tear layers, deteriorate their quality and dry out the eye.
Ideally, you should not wear lenses every day, but only when necessary. Of course, for a person with poor eyesight this is simply impossible. Replace lenses with glasses? Again, this is inconvenient for many.
Therefore, if you have poor vision, there are two options:
Dry eye syndrome often worsens after laser vision correction. But this happens if the preparation for correction was carried out incorrectly. Before surgery, the above-mentioned Schirmer test, a dry eye test, should be done. And if necessary, treat this syndrome, but not with drops, but with more effective laser stimulation. If this technology is followed, then laser correction will take place without problems.
Some medications cause dry eyes. These are usually antidepressants and oral medications. The drugs affect hormonal levels, which, in turn, affect the fatty component of tears. The tear film loses its stability and the eye dries out. In parallel with taking these medications, it is better to use artificial tears.
Diabetes, in addition to many other unpleasant consequences, it also causes dry eyes. But with proper compensatory therapy, such a problem does not arise.
During treatment conjunctivitis use antibiotics that impair the quality of tears. Therefore, after treating this disease, it is imperative to be treated for dry eye syndrome.
Blepharitis- chronic inflammation of the eyelids, which also impairs the quality of tears. Until it is treated, dry eyes will not go away.
And finally, let me remind you: anti-glare glasses for working at the computer, glasses with holes for relaxation - these are all successful marketing ploys. They are absolutely useless for the eyes.
In the 21st century, a person’s requirements for the quality of vision have become comparable to the requirements that he makes for the quality of life. People want to see well near and far, not experience computer fatigue and twilight fatigue, and quickly respond to environmental changes.
The quality of vision must be maintained at a high level at least during the period of working capacity. Due to the development of excimer laser surgery, including operations LASIK, PTK, PRK, LASEK, it has become possible to restore vision in most cases. At the same time, the widespread use of such interventions has led to increased attention from doctors to the quality of vision in the postoperative period. At the end of 2001, more than 300 thousand people abandoned contact correction in favor of laser surgery. This represents more than 10% of all people who require optical vision correction. In some cases, complications occur in the postoperative period, the most common of which is dry eye syndrome. This unpleasant condition after excimer laser surgery is a very pressing problem affecting a large number of patients. In this regard, adequate treatment of dry eye syndrome and the development of effective preventive measures are required.
Quite often, people turn to an ophthalmologist due to dry eyes. This condition is usually associated with a disruption in the formation of the tear film that covers the cornea of the eyeball. Tear is a lubricant that prevents drying of the surface of the eye, moisturizes the space between the eye and eyelids, protects the organ of vision from pathogenic microorganisms, and also nourishes the cornea. The tear film consists of three layers. The mucous layer is in contact with the surface of the eyeball; it is a kind of foundation on which the remaining layers are attached. The middle layer is aqueous, its composition is dominated by water (98%) and nutrients (proteins, salts, etc.). The outer layer is fatty, it is quite thin, but at the same time it reliably protects the eye and prevents moisture evaporation.
Tears are synthesized in several glands that are located around the eye. The water base is secreted by the lacrimal gland of the upper eyelid. The fatty and mucous components are synthesized by glands located in the conjunctiva and the thickness of the eyelids. When blinking, the liquid is evenly distributed over the surface of the cornea. If there is excess tear, it enters the lacrimal canaliculi in the medial corner of the eye. These tubules empty into the lacrimal sac, from which tears flow through the nasolacrimal duct into the nasal cavity. This anatomical structure explains the fact that when a person cries, fluid comes out of the nose.
Tear synthesis is sometimes triggered reflexively by extraocular stimuli, which include pain or emotion. Such a tear is not able to cope with irritation, therefore, with dry eye syndrome, all the symptoms of the disease persist.
There are many causes of dry eyes. Physiological aging predominates among them. With age, the amount of fat secretion decreases significantly (by the age of 65, the secretion is less than half of the level observed at 18 years). This process is more noticeable in women, since their skin is often drier. Due to the thinning of the fatty layer of the tear film, its stability decreases. In this case, there is a faster evaporation of moisture from the surface of the eye, which exposes dry spots on the cornea.
Other factors that affect tear film stability include dry, windy, hot climates, air conditioning, cigarette smoke, and high altitudes. All these factors aggravate the symptoms of dry eye syndrome. Most people experience discomfort in their eyes when reading or working at a computer for a long time. To alleviate the condition, you need to periodically be distracted from work and make blinking movements.
It is also quite common for patients to experience symptoms of dry eye syndrome when using contact lenses. This is due to the fact that the substance of the contact lens is capable of absorbing moisture from the surface of the eye. Systemic pathologies (thyroid disease, vitamin A deficiency, Sjögren's syndrome, Parkinson's disease), as well as taking certain medications, can also lead to dryness. In women, similar eye problems arise due to hormonal changes during menopause.
With dry eye syndrome, the patient experiences the following manifestations of the disease:
To determine dry eye syndrome, you need to collect a history of the disease, check the rate of tear formation, the rate of its evaporation, and the quality of the tear film. Using special drops, you can assess the presence of dry eyes and the severity of these manifestations.
Treatment for dry eye syndrome should be individualized and selected depending on the cause of the disease. To reduce symptoms, it is enough to use a tear substitute in drops or gels. Depending on the thickness of the artificial tear, the duration of its action also varies. In any case, it is preferable to use drugs that do not contain preservatives, since this reduces the risk of developing allergies. You should not use drops that only eliminate redness of the eyes, since the effect is purely symptomatic, and due to vasoconstriction, there is an additional restriction in the production of tear fluid.
Another method of combating dryness is to seal the tear duct with a special plastic plug. This reduces the loss of tear fluid, as its outflow from the surface of the eye is reduced. This plug can be temporary, in which case it is made of absorbable collagen. If the plug is made of silicone, its service life increases significantly.
Along with treatment, you should follow some rules in your daily life that will help you cope with dry eyes. You need to drink 8-10 glasses of liquid daily to speed up metabolism and maintain water balance in the body. It is advisable to blink more often to distribute tears evenly over the surface of the eye. There is no need to rub your eyes, as this will only increase irritation.
It is important to note that treatment for dry eye syndrome not only improves the general well-being and improves the patient’s quality of life, but also maintains the cornea in normal condition.
After laser eye surgery there is no 100% guarantee that vision can be restored or no complications will arise.
The visual organ has a fragile structure, and after laser correction it becomes much weaker, so patients should not engage in heavy physical activity.
Especially in the first three months After surgery, the eyes require peace of mind. Laser correction affects the contrast sensitivity of the visual organs, so driving a car at night is not recommended. And also after the procedure, dryness, discomfort, pain, and burning may appear.
Eye problems may occur even if you rub them with your hands.
The medicine is prescribed by an ophthalmologist to improve the condition of the visual organs after LKZ.
All sterile drops, and cannot have a negative impact.
They are designed to moisturize the eyes, relieve dryness, fatigue, get rid of conjunctivitis, and swelling.
Attention! Drops should be selected by an ophthalmologist individually for a specific case.
Preparation for instillation:
Instillation procedure:
Patients after laser correction are discharged two types of drops:
Important! It is recommended to choose a medicine or replace it with an analogue only after discussion with your doctor. Schedule and period of use drops are also indicated by the ophthalmologist.
After PRK surgery, ophthalmologists most often prescribe Tobrex and Oftan.
In 1 ml liquid contained 3 mg antibiotic, used for most diseases of the visual organs, which belongs to aminoglycosides.
Photo 1. Tobrex eye drops, 0.3%, 5 ml, from the manufacturer Alcon.
Tobrex will not work:
Reference! When breastfeeding, you can take medicine if it is absolutely necessary, but with the permission of an ophthalmologist.
Indications:
In 1 ml liquid contained 0.7 mg cytochrome C, 2 mg adenosine, 20 mg nicotinamide.
Photo 2. Eye drops, Oftan Dexamethasone, 1 mg/ml, 5 ml, from the manufacturer Santen.
The medicine should not be taken:
The medicine is instilled into the conjunctival sac 1-2 drops three times a day.
Indications:
Instill the medicine 1-2 drops into the conjunctival sac every 5 hours.
In the first two days the frequency between procedures can be 2 hours.
Indications:
The medicine consists of water for injection, sodium citrate, anhydrous citric acid, sorbitol. Liquid is instilled three times a day. If fatigue or dry eyes bother you too often, you can instill them more often.
Indications:
After laser correction, Fetmo-Lasik is prescribed for recovery Dexamethasone, Levomecitin, Oftagel.
In 1 ml contained 1 mg dexamethasone. When inflammatory processes are detected in the first two days It is recommended to instill into the conjunctival sac 1-2 drops every two hours. If the inflammation begins to go away - every 5 hours. After operations on the first day liquid is instilled 4 times a day. In the next two weeks - 3 times a day.
What could be the indications? This:
Photo 3. Dexamethasone eye drops, 0.1%, 10 ml, from the manufacturer Farmak.
In 1 ml contained 2.5 mg chloramphenicol. Drops are used 4 times a day, 500 mg. Treatment duration is approx. 10 days.
Indications:
Dry eye syndrome, fluctuations in visual acuity, and foreign body sensation are temporarily worsened after both LASIK and PRK, the study found.
A systematic randomized clinical trial included 34 patients treated with wavefront-guided LASIK in one eye and PRK in the other. Before and after surgery, patients filled out questionnaires asking about the severity of dry eye symptoms, fluctuations in visual acuity, and foreign body sensation in the eye.
With both LASIK and PRK, dry eye symptoms increased significantly after surgery. One month after surgery, the severity of dry eye syndrome also increased significantly. Only three months later, the manifestations of symptoms and the values of parameters characterizing the presence of dry eye syndrome returned to the original values for LASIK and PRK.
Variations in visual acuity increased significantly over 6 months after both LASIK and PRK. This indicator returned to baseline values 12 months after surgery.
The slight increase in foreign body sensation in the eye that patients experienced one month after LASIK and PRK returned to baseline levels three months after surgery.
Material prepared by: Theochem
Thanks to scientific research, it was possible to establish that PRK and LASIK lead to the formation of dry eye syndrome with the same frequency. Previously, it was believed that LASIK caused this complication much less frequently.
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