Following cosmetic eyelid surgery, the eyes themselves may feel irritated for any number of reasons. Symptoms such as itching, burning, grittiness, stickiness, dryness, or even excessive watering are not at all uncommon to some degree during the first few days and weeks (and rarely months) after blepharoplasty. While annoying, such mild irritation is not unexpected and is usually nothing more than part of the normal inconveniences of healing.

Much of such irritation is caused by swelling from the trauma of surgery and by temporary weakened or incomplete closure of the eyelids. Since the orbicularis muscles (the eyelid's closing muscle) is cut through and may sometimes be trimmed as a routine part of upper and/or lower eyelid blepharoplasty, it takes a while (up to several months) for the muscle to recover its full strength.

Until then, blinking is often not as crisp and forceful as it was before surgery, which causes less efficient spreading of the eye's natural tears over the eye surface. Evaporation may be increased, resulting in symptoms related to this relative dryness. In patients who suffered from "dry eyes" even before surgery, symptoms will be more intense. Likewise, patients may find themselves more sensitive to adverse environmental conditions (wind, dust, dry air, cold air) in the first weeks and months after surgery.

(Immediately after surgery, there is increased production of tears, mucus, and blood. Additional advice for managing symptoms in the early postoperative period is contained in the Insider's Guide to Blepharoplasty and is not repeated here.)

Occasionally, an eye may become excessively watery rather than dry as a temporary consequence of healing and for the same reasons as already noted. As a response to the increased evaporation of the eye's natural moisturizing tear layer, some patients will overproduce a second type of tear (the tear that kicks in when we cry) to try to "wash away" the irritation. This second tear is quite dilute and not particularly effective as a moisturizer -- hence, added aggravation rather than relief.

The ultimate remedy in almost all cases is simply allowing normal healing to progress. As eyelid swelling abates and the power of the orbicularis muscle returns, the normal dynamics of blinking and tear distribution are reestablished. Until then, the use of artificial lubricants can be soothing.

The most commonly used preparation is "artificial tears" (sometimes labeled "ocular lubricant"), which are available under many brand names over-the-counter. Such tears may be used as often as is comfortable and will not interfere with the healing of the blepharoplasty or worsen other eye conditions such as glaucoma. Usually one drop instilled three or four times a day is sufficient. Since artificial tears are quickly blinked away, using them less often than this is usually not effective. On the other hand, using them more frequently does not pose a problem. Instilling more than one drop at a time, however, is a waste of tears; an eye will only hold about one-half a drop.

Artificial tears come in different viscosities and with or without preservatives. For use after blepharoplasty, it is probably best to stick with the non-preserved version, since preservative may irritate some eyes and compound your symptoms. Non-preserved tears come in individually-packaged droperettes, which can be a bit inconvenient. If this seems too much a nuisance, some of the newer forms of preserved tears that use an especially mild and transient preservative may be tried instead (Gen-Teal, Refresh, Hypotears Select).

For stronger moisturization, you may wish to use an extra-strength preparation named Celluvisc. Resembling Karo syrup in consistency, the drop may cause mild blurring of vision. While Celluvisc is available over-the-counter, it is sometimes tucked away by the pharmacists to keep it out of the hands of patients who mistake it for just another artificial tear. If you don't find it out on the shelf, ask.

For treating more annoying dryness or to achieve prolonged moisturization while asleep, artificial tears also come in ointment or gel form. Used during the day, they can cause more blurring of vision than most people will accept, but nighttime use is better tolerated. Examples of such ointments are Lacrilube, Refresh PM, and Gen-Teal Gel.

If you can't find the exact brands listed here, ask your pharmacist for a recommendation. There are many brands and even some "generic" preparations, all of which resemble one another.

It should go without saying that if your symptoms are extreme or are increasing rather than decreasing or are associated with redness and discharge or a decrease in the vision, call your surgeon.