A review of oculoplastic surgery and ocular surface disorders

Abstract Background: Ocular surface health is closely related to the condition of the ocular adnexa, particularly the eyelids. Both ocular adnexal disorders and oculoplastic procedures performed to treat them can cause ocular surface disorders (OSD). In this review, we aimed to summarize the relationship between oculoplastic procedures and OSD. Methods: In this narrative review, an electronic search of the PubMed/MEDLINE database was conducted using various combinations of keywords including “oculoplastic surgery,” “ocular surface disorders,” “dry eye,” and “management,” without time or language limitations, to include studies concerning oculoplastic surgery and OSD. Results: We included articles involving oculoplastic procedures and OSD with discussions of preventive approaches and management strategies in this context. For a systematic approach, the preoperative assessments and postoperative treatment of patients were retrieved and summarized. Preoperative preventive measures included evaluation of tear film break-up time, tear osmolarity, tear meniscus area and height measurement by anterior segment optic coherence tomography, lipid layer thickness by interferometer, corneal staining and Oxford Scheme, Schirmer test, blink rate and completeness, ocular surface disease index scoring, eyelid closure, and Bell’s phenomenon. Postoperative assessments included the presence and severity of dry eye and early management of dry eye with artificial tears, topical anti-inflammatory medications, and night taping; evaluation of the presence of chemosis, and, if present, management with pharmacologic, mechanical, or surgical therapies when needed; and prompt detection and treatment of lagophthalmos and consequent exposure keratopathy. Conclusions: Careful preoperative examination of the ocular surface is mandatory to reduce or eliminate complications after oculoplastic surgery. Ocular surface-related complications that surgeons encounter after oculoplastic surgery should be promptly diagnosed and treated. Keywords: ectropion entropion lagophthalmos ocular surface oculoplastic surgery