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Question 7#

Which of the following is not true for a patient seeking lower lid blepharoplasty?

a. A Schirmer I test showing less than 10mm at 5 minutes would be a relative contra-indication
b. A ‘snap’ test should always be performed
c. Excess skin below the level of the orbital margin is usually corrected by lower lid blepharoplasty
d. Blindness is a rare but recognized complication
e. Hamra’s procedure redistributes the fat rather than excising it

Correct Answer is C

Comment:

Excess skin below the level of the orbital margin is usually corrected by lower lid blepharoplasty. This statement is incorrect. Schirmer’s test is for lacrimation. The Schirmer I test is performed without anaesthesia and tests for reflex and basic secretion. Less than 10mm of moistening of the paper at 5 minutes is considered positive. It is worth noting that McKinney and Byun showed that Schirmer’s test did not correlate well with postblepharoplasty dry eyes challenging the rationale for routine use of this test prior to blepharoplasty. Anecdotally, few surgeons actually perform this test routinely. The snap test is for excessive lid laxity and must be assessed prior to surgery. Skin folds below the inferior orbital margin (sometimes called ‘festoons’) are rarely improved by blepharoplasty alone. Hamra described the redistribution of lower lid fat to restore the contours of youth to the lower lid and avoid the risk of a ‘cadaveric’ eye.

References:

1. McKinney P, Byun M. The value of tear film breakup and Schirmer’s tests in preoperative blepharoplasty evaluation. Plast Reconstr Surg 1999; 104(2): 566-9; discussion 570-3.