Ocular surface implications of upper and lower blepharoplasty: A DEWS III-guided review of mechanisms, risks, and management strategies

Upper and lower eyelid blepharoplasty is one of the most commonly performed oculoplastic surgeries worldwide, serving both aesthetic enhancement and functional purposes. While blepharoplasty enhances facial aesthetics and expands the visual field effectively, it carries significant ocular surface complication risks. These operations may impact ocular surface health by changing eyelid structure, influencing blinking behavior, and affecting tear film homeostasis, predisposing patients to or aggravating preexisting dry eye disease (DED). Therefore, a meticulous preoperative assessment for dry eye, cautious surgical approaches, and diligent postoperative care are necessary to prevent surgery-induced or aggravated DED and achieve optimal patient satisfaction and surgical success. This narrative review evaluates recent evidence and TFOS DEWS II and III consensus data to define causative mechanisms, recognize predisposing factors, and present management strategies to improve surgical safety and patient outcomes.

Keywords: Blepharoplasty, Dry Eye Disease, DEWS II, DEWS III, Blink Mechanics, Ocular Surface.