2002.11.03: Engelsk øjenprofessor:
”I am delighted thad adding the skin graft did improve eyelid closure and make your eyes more comfortable. As I said in my report of 9th february, a copy of which I enclose, if your symptoms could not be controlled with the regime that I had suggested, the next stage would be to consider skin grafting to the upper lids and possible entropion surgery to the lower lids. The skin grafting to the upper lids has clearly improved you. You still have the problem of the tear production and blink and I strongly recommend that you continue with the regime that I suggested of hot bathing and eyelid margin cleaning to maximise your tear production. It is difficult to know exactly what went wrong with the blepharoplasty operation to cause your dry eyes and discomfort but clearly too much skin was removed for you and the effect of this upset your blink mechanism and tear production. Adding skin has improved the situation but has not cured it and you need all the help you can to improve your tearsfilm as I have suggested.

The other problem that you had was the tendancy to an entropion such that the lower lids rolled inwards. It is difficult to work out the exact mechanism by which this was caused but as I said in my report of the 9th February 2001 you might require entropion surgery and as your letter suggest this may indeed be the case.

In summary therefore I think that you developed sore eyes following the four lid blepharoplasty because too much tissue was removed for your eyes and as a result your blink and tearfilm were disrupted.

Since you did not respond to lubricants and other measures to improve your tearfilm you had to undergo an operation to add skind and to free scartissue which will improved your eyelids closure and blink. Since you are still uncomfortable you need to continue with lubricants and measures to improve your tearfilm. If these on their own do not control your symptoms you may require lower lid entropion surgery.