Authors: Mišo Gostimir, Ahsen Hussain

Author Disclosure Block: M. Gostimir: None. A. Hussain: None.

Abstract Body:

Purpose: Keratoconjunctivitis sicca, or dry eye disease, is a common condition that affects many patients with oculoplastic or orbital conditions. The potential impact of these conditions in causing or worsening dry eye disease must be considered while managing these patients. Furthermore, dry eye must be considered as a potential complication of oculoplastic or orbital procedures which may alter anatomical structures involved in the lacrimal system. Thus, the purpose of this review was to provide a comprehensive summary of all existing evidence related to oculoplastic conditions and procedures that may cause or worsen dry-eye disease.
Study Design: Systematic review.
Methods: A literature search of the MEDLINE, EMBASE, and Scopus databases was conducted to identify all relevant studies from 1946 to 2018. Publications describing (1) an oculoplastic or orbital disorder which can cause or contribute to dry eye, or (2) an oculoplastic or orbital procedure which can cause or worsen dry eye, were included. Studies reporting dry eye disease subjectively (e.g. patient-reported symptoms) and objectively (e.g. Schirmer test results, OSDI, tear breakup time, tear film analysis, exam findings, etc.) were included. There were no restrictions based on study type or subject type. Studies were excluded if the disorder or procedure of interest was not within the realm of ophthalmic plastic surgery, or if the outcome was an improvement, rather than the development or worsening, of dry eye disease.
Results: Following the review of 1437 search results, a total of 166 articles were included in the review. Of these, 52 articles described an oculoplastic or orbital disorder and 114 articles described procedure in association with the development or worsening of dry eye disease. The reported disorders included thyroid eye disease, IgG4-related disease, blepharospasm, lid wiper epitheliopathy, eyelid laxity, entropion/ectropion, lagophthalmos, and ptosis. The reported procedures included blepharoplasties, botulinum toxin injections, dacryocystorhinostomy, and various applications of radiation for orbital conditions. The most-studied conditions included thyroid eye disease, ptosis, and blepharospasm. The most-studied procedures included blepharoplasties, botulinum toxin injections, and radiotherapy.
Conclusions: Dry eye disease is well-reported in relation to orbital conditions and complications of oculoplastic procedures. The available evidence has been summarized and presented in a logical format for application to practice. While dry eye management must be considered in the context of certain orbital conditions, the evidence for dry eye disease as a complication of certain procedures warrants a more detailed and individualized management approach, especially in patients with already-present dry eye disease.