The value of tear film breakup and Schirmer's tests in preoperative blepharoplasty evaluation.

The authors published their article on the value of tear film breakup and Schirmer's tests in preoperative blepharoplasty evaluation in 1989. The purpose of this update is to expand the original article in light of refinements and experiences in subsequent years. It was concluded in the 1989 article that the abnormal tear film breakup and Schirmer's tests were not good predictors of possible postblepharoplasty dry eye complications. It was concluded in the review that the anatomy and the history including scleral show, lagophtholmus, negative vector, snap test, previous surgery, increased blinking, dryness, grittiness and pain were more important predictors of postoperative dry eye problems than the ocular tests. The authors' opinion remains so, and they do less preoperative tear film testing and place more emphasis on the history and the anatomy as predictors of potential problems. In this follow-up to the 1989 article, the authors include a survey from several surgeons as to how they evaluate their patients for elective aesthetic blepharoplasty, which in large measure confirms the authors' practice.