Changes in pupillographic and ocular surface parameters following upper eyelid blepharoplasty

To evaluate changes in pupillary responses, meibomian gland morphology, and tear film stability following upper eyelid blepharoplasty and to characterize the postoperative patterns of these parameters at the third postoperative month.

This retrospective longitudinal observational study included 90 eyes of 45 patients (mean age, 57.6 ± 9.18 years) who underwent orbicularis-preserving upper eyelid blepharoplasty. Preoperative and third-month postoperative assessments comprised pupillography (scotopic, mesopic, and photopic pupil diameters; 10-s redilation velocity), non-contact infrared meibography, and noninvasive tear film breakup time (NI-FBUT and NI-AvgBUT). Preoperative and postoperative outcomes were analyzed using linear mixed-effects models to account for within-patient inter-eye correlation.

Photopic and mesopic pupil diameters showed significant postoperative reductions (p = 0.011 and p = 0.002, respectively), accompanied by a decrease in redilation velocity (p = 0.018), while scotopic pupil diameter remained unchanged. Meibomian gland loss area showed a mild, nonsignificant increase, while NI-FBUT and NI-AvgBUT showed nonsignificant postoperative increases.

Upper eyelid blepharoplasty was associated with small reductions in mesopic and photopic pupil diameters and redilation velocity at the third postoperative month. No statistically significant changes were detected in the evaluated tear-film or meibography parameters. The physiological mechanisms underlying the observed pupillometric changes cannot be determined from the present study.