Cosmetic eyelid surgery and dry eyes: a review

With the growing interest in facial aesthetics, cosmetic eyelid surgery has gained popularity and ranks among the most commonly performed procedures in cosmetic surgery. The relationship between cosmetic eyelid surgeries and ocular surface health is of considerable clinical importance. The concurrent increase in the prevalence of dry eyes and the number of cosmetic eyelid surgeries have amplified the importance of understanding and managing postoperative dry eyes, making it a key consideration in surgical planning and patient care. This review aims to provide a comprehensive overview of the interplay between cosmetic eyelid procedures, particularly upper and lower blepharoplasty and blepharoptosis repair, and the development or exacerbation of dry eyes, with emphasis on preventive strategies. A systemic review of the literature was conducted between January 2000 and March 2025. A total of 44 studies were eligible for inclusion. We focused on the pathophysiological mechanisms by which eyelid surgery affects ocular surface homeostasis. Special attention was given to surgical factors influencing eyelid closure, anterior lamella shortening, blink dynamics, tear film stability, and ocular surface exposure. Preoperative evaluation tools, diagnostic tools, and risk factors for postoperative dry eye were also examined. Cosmetic eyelid surgeries may contribute to impaired blink function, altered tear film dynamics, and increased ocular surface exposure, which together elevate the risk of postoperative dry eyes. Patients with preexisting dry eye, elderly individuals, female, and Asian populations appear to be particularly susceptible. Strategies such as careful preoperative assessment, risk stratification, and conservative surgical planning can mitigate complications and improve outcomes. This review offers practical perioperative strategies to reduce the risk of dry eye complications and enhance patient outcomes. By integrating the current evidence, this study aims to assist clinicians in optimizing surgical decision-making, patient counselling, and preventing postoperative dry eyes in individuals undergoing cosmetic eyelid surgery.