Tear meniscus and corneal epithelial thickness changes after upper blepharoplasty, as evidenced by anterior segment optical coherence tomography

Background Upper eyelid dermatochalasis is commonly associated with both cosmetic concerns and functional ocular surface issues, including changes in tear film dynamics and the corneal epithelium. Upper blepharoplasty, a corrective surgical procedure, may affect these parameters by altering eyelid mechanics. Purpose This study aimed to assess changes in tear meniscus height (TMH), tear meniscus area (TMA), and corneal epithelial thickness (CET) following upper blepharoplasty, using anterior segment optical coherence tomography (AS-OCT). Patients and methods This prospective, interventional study was conducted on 40 patients with dermatochalasis who underwent standardized transcutaneous upper blepharoplasty at Benha University Hospital. Preoperative and postoperative evaluations included measurements of TMH, TMA, and CET (central, superior, superotemporal, and superonasal) using AS-OCT. Results The mean patient age was 49±11 years, and 87.5% of the participants were female. Postoperatively, TMH increased significantly from 358 to 409 μm ( P =0.009). TMA also showed an increase from 0.04 to 0.05 mm 2 . Significant postoperative increases were observed in superior ( P <0.001), superotemporal ( P <0.001), and superonasal CET ( P <0.001), while central CET remained unchanged ( P =0.213). Female patients demonstrated greater improvements in both TMH and superior CET. Conclusion Upper blepharoplasty significantly improves tear reservoir parameters and regional CET. AS-OCT proves to be a sensitive, noninvasive method for quantifying these changes, offering advantages over conventional dry eye tests.