Constant Eye Discomfort/Symptoms/Pain after Bleph-Ex and other Eyelid Procedures


We have seen a few patients over the years that swear one of the following procedures caused chronic, unremitting eye pain and/or eyelid pain. It is very uncommon for these procedures to cause a worsening of symptoms. But the risk is not 0%. The underlying cause is likely inflammation in the sub-epithelial layers (that is not visible yet with our microscopes nor meibography photos) which stimulate surround nerves to keep firing. 

Because I have heard this complaint so often after any eyelid procedure, I usually recommend a baseline meibography before any eye procedure so patients and I can determine the risk of having chronic dry eye symptoms after any eye procedure. 

More specific information is included below. Treatment options are at the end. 

1. Chalazion removal: we have hundreds of patients who had told us their eyelid never felt the same after chalazion/stye removal. This is likely from the scar of the surgery which can lead to the feeling of sandpaper rubbing the sensitive cornea every second of every day. Millions of patients have had eyelid surgery so the risk of having chronic eye symptoms or pain after eyelid surgery is less than 1% in my estimation. 

2. Blepharoplasty/Eyelid lifts: Worsening dry eye or new onset dry eye symptoms is the number 1 complaint after eyelid lifts. Usually it is temporary but in some cases it is debilitating. I have seen hundreds of patients who have noted this, likely because this procedure is so common. Lifting the lagging upper eyelid will increase the surface area of the eyeball which can make dry eye symptoms worse. Years ago, some oculoplastic eye surgeons would cut into the meibomian glands which would likely destroy those oil glands fully (we did not have meibography back then to prove this and since then, techniques have improved to avoid the meibomian glands).

3. Eyelid tattoo: I have seen 4 patients who “swear” this caused chronic foreign body sensation. One of the 4 was disabled and thus had treatment with autologous stem cell insertions into the meibomian glands in that area. This provided about 6months of relief the first time and so far at least 8 months the second time. The eyelid tattoo likely caused an intense inflammatory reaction that caused sub-epithelial scar tissue that triggered the firing of surround nerve tissue. 

4. Bleph-Ex: we have 2 patients thus far who have reported that Bleph-Ex made their eye more irritated which did not improve for months. The same process is likely happening: Bleph-Ex (and all of these procedures) stir up intense inflammatory reaction that caused sub-epithelial scar tissue that triggered the firing of surround nerve tissue. 

5. Lipiflow: I have 2 patient thus far that felt this made her feel worse for months after Lipiflow. It is well known that the eyes can feel more irritated after Lipiflow and that this irritation can last 4-6 weeks. Rarely does it last longer, but we have seen 2 that noted it lasted for months. 

6. IPL: I have seen 2 patients out of thousands who have had IPL who noted their eye felt worse for a few months. 

7. Meibomain gland probing: we have seen 2 patients note their symptoms worsened for a few weeks after probing out of hundreds of patients. 

8. Cataract surgery: the number one complaint after cataract surgery is dry eye symptoms (ie, foreign body sensation, discomfort, dryness, pain, redness). Part of this is from the surgery but the extent of the symptoms often depends on how much oil their meibomiang glands are producing. 


Treatment Options:

Many of you have seen my step ladder sheet. 

Briefly, the below can help with chronic pain issues. 

1.    1.   Cold compresses
over the area if inflamed or painful; but warm compresses & massaging are
currently the only way to keep the Meibomian gland pumping. Thus I tell
patients to apply heat first followed by cold at least 2x per day. Rest of the
time, apply cold compresses for any pain, swelling, itching, redness.

2.    2.    Anti-inflammatories:
the most effective in my experience are the following: Autologous Serum, PRP, Cord
Blood Serum, and/or autologous stem cell drops over the inflamed area. We have
inserted these into Meibomian glands as well. My theory is that a combination
of the last 3 is the best.

3.     3.   Xiidra,
Restasis, Cequa: are anti-inflammatories but do not seem to help as much as the
cellular therapy above.

4.    4.  Anti-inflammatory
diet: this is a must in my experience: gluten-free, sugar-free, dairy-free. It
is the diet I have been on for years.

5.   5.   Steroids: if
nothing helps, we then use steroid creams and drops but often this is limited
around the eye as it can thin the skin, increase the risk of cataracts and
glaucoma if used long term.

I hope this

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