LASIK, Cataract Surgery, Glaucoma, and Blepharoplasty: Which Eye Surgery Should Come First, Why Dry Eye Decides the Timing, What a LASIK Flap or a Glaucoma Bleb Changes About Eyelid Surgery, and Which Drops Stay On

A patient sits down for a blepharoplasty consultation and fills out the intake form. Under "prior surgeries" they write a knee scope and a C-section. They do not write LASIK, because it was twenty years ago and felt more like a dental cleaning than an operation. They do not mention that their eye doctor said, at the last visit, that a cataract is "starting." And the nightly glaucoma drop does not make the medication list, because it is an eye drop, and who counts eye drops.

Each of those omissions matters to eyelid surgery, and eyelid surgery matters to each of them. Blepharoplasty after LASIK, eyelid surgery before or after cataract surgery, and lid surgery in a person treated for glaucoma are not exotic situations. They are the ordinary situation for a large share of people in their fifties, sixties, and seventies, which is exactly the age range in which eyelid surgery is most often done. The National Eye Institute describes cataract as extremely common with age, with most Americans having one or having had cataract surgery by around eighty, and glaucoma becomes steadily more common across the same decades. Millions of Americans have had laser vision correction since the late 1990s, and that cohort is now reaching the age of hooded upper lids and lower lid bags.

The operations are performed by different specialists who do not always talk to one another. An ophthalmologist doing a cataract operation may not know a lid lift is planned for spring. A plastic surgeon planning that lid lift may not know the patient's lens measurements were taken last month. This piece walks through why the eye and the lid behave as one system, how laser vision correction changes eyelid surgery and the reverse, which operation tends to go first when both cataract and eyelid surgery are on the table, what glaucoma treatment changes, and how to plan the operation and the recovery so nobody is surprised.

Why the eyelid and the eye behave as one system

The short answer: the eyelids spread and drain the tear film, shield the cornea, and even press lightly on its curve, so any operation that changes lid position or blink can change how comfortable the eye is and how accurately the cornea can be measured, and any eye operation that weakens the tear film makes the eye less tolerant of lid surgery.

It helps to picture the front of the eye as three layers working together. The cornea is the clear dome that does most of the focusing. Over it lies the tear film, a layer only a few millionths of a meter thick, built from oil secreted by the meibomian glands along the lid margins, a watery layer from the lacrimal gland, and mucus from the surface cells. The eyelids sit on top, and with every blink they wipe the tear film evenly across the cornea and push old tears toward the drainage openings near the inner corner.

That arrangement has three consequences for anyone planning lid surgery.

• Blink and closure. An upper blepharoplasty removes skin and sometimes a strip of muscle. For days or weeks afterward, swelling and tightness can keep the lids from closing completely, a condition called lagophthalmos. Lower lid surgery can loosen the lid's contact with the eye or pull it down, exposing more white below the iris. Either way, more of the cornea is left uncovered and the tear film evaporates faster.
• Tear production and nerves. The cornea is among the most densely innervated tissues in the body, and those nerves drive reflex tearing and blinking. Operations that cut corneal nerves, LASIK above all, dull that feedback loop for months, sometimes longer.
• Corneal shape. A heavy or drooping upper lid rests on the cornea and can subtly flatten or tilt its curve. Lifting the lid can shift measured astigmatism by a small amount. Published studies of upper blepharoplasty and ptosis repair have documented these changes, usually modest, sometimes enough to matter for someone about to have a lens power calculated to a fraction of a diopter.

The 2017 Tear Film and Ocular Surface Society Dry Eye Workshop report, known as TFOS DEWS II, defines dry eye disease as a loss of tear film balance with symptoms, inflammation, and nerve changes, and lists both eye surgery and eyelid surgery among recognized causes. The piece on dry eye after eyelid surgery covers that problem in detail. The point here is broader: every one of the operations in this article draws on the same small reserve of tear film and corneal tolerance, and stacking them carelessly is how a patient ends up with an eye that burns every afternoon for a year.

LASIK, PRK, and SMILE before or after eyelid surgery

The short answer: prior LASIK does not rule out blepharoplasty, but it raises the stakes on dry eye, calls for a careful pre-operative tear assessment and a conservative plan for the lower lid, and requires that the surgeon and anesthesia team know a corneal flap is present; if laser vision correction is still to come, most ophthalmologists prefer the lids to be done and stable first.

Three operations dominate laser vision correction. LASIK uses a laser or a fine blade to cut a thin hinged flap in the cornea, reshapes the tissue underneath, and lays the flap back down. PRK removes the surface layer of the cornea and reshapes it directly, with no flap, and the surface heals over in days. SMILE, approved by the Food and Drug Administration in 2016, uses a laser to carve a small disc of tissue inside the cornea and removes it through a tiny incision. The FDA's consumer guidance on LASIK lists dry eye as a recognized side effect, and studies consistently find that a large share of patients have dry eye symptoms in the first months after LASIK, with most improving over six to twelve months as the corneal nerves regrow, and a minority who never return fully to baseline.

That is the first reason prior LASIK matters to a lid surgeon: a cornea that has lost part of its nerve supply is less able to sense dryness and drive reflex tears. A patient who seemed fine before blepharoplasty may tip into symptomatic dry eye after it, because the operation adds exposure and evaporation to a surface that was already running on a thin margin. The second reason is the flap. A LASIK flap adheres well but never regains the full strength of an uncut cornea, and traumatic flap dislocation has been reported years after the original surgery. Eyelid surgery does not involve pressing on the cornea, but the patient is asleep or sedated, protective shields may be placed, and an eye that is rubbed hard in a groggy recovery room is at small but real risk. Telling the team about the flap is the whole remedy.

What a sensible plan looks like when LASIK is already in the past:

• Wait out the dry eye. If the LASIK is recent, most surgeons want the ocular surface to settle before adding lid surgery. There is no single universal interval, but waiting at least several months, and longer if dry eye symptoms are still active, is common practice. A patient who had LASIK decades ago may be fully stable, or may have chronic dry eye that has simply become normal to them.
• Measure, do not ask. "Do your eyes feel dry?" is a weak screen. A Schirmer test, tear breakup time, and a look at the lid margins and meibomian glands under the slit lamp take minutes. Patients who also have conditions that dry the eye, such as thyroid eye disease (see the piece on thyroid eye disease and eyelid surgery), recent isotretinoin use (see the piece on the isotretinoin waiting period), or autoimmune disease, need that exam more, not less.
• Be conservative with skin. In an eye with a reduced reserve, the cost of removing a few extra millimeters of upper lid skin is paid in exposure. A surgeon who plans for prior LASIK will usually take a measured amount, and may favor a less aggressive approach to the lower lid, protecting its support with techniques discussed in the piece on revision blepharoplasty and lower lid retraction.
• Treat the surface before surgery. Lubricants, warm compresses and lid hygiene for meibomian gland dysfunction, and prescription anti-inflammatory drops are all reasonable to start weeks ahead, the same way a cataract surgeon would optimize the surface before measuring.

When the order is still open, the situation reverses. A person who wants both an eyelid lift and laser vision correction should generally have the lid surgery first. Lifting a heavy lid can change corneal shape and the tear film, and a refractive surgeon wants stable, repeatable measurements before reshaping tissue permanently. Most will want the lids healed and the measurements consistent across visits, typically a matter of months, before treating. A patient who has the laser correction first and the lids afterward risks a small shift in the refraction they just paid to fix, plus the dry eye of two operations landing back to back. The same logic applies to a canthoplasty or fox-eye procedure, which changes how the lower lid meets the eye and can widen exposure even more than a standard lid lift.

Contact lens wearers sit in the middle of this conversation. Long-term rigid and soft lens wear is a recognized cause of acquired ptosis, a stretching of the muscle that lifts the lid, which is different from the excess skin of hooded lids; the piece on eyelid ptosis versus blepharoplasty and the piece on hooded eyes versus brow ptosis explain why the diagnosis determines the operation. Lenses come out on the day of surgery, as covered in the piece on day-of-surgery rules, and usually stay out until the surgeon clears them, often a week or two, which is a long time for someone whose glasses prescription is out of date.

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The eyelid and the cornea share one tear film. Whoever operates second is working on a surface the first surgeon already changed, and the patient is the only person guaranteed to know both operations are coming.

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Cataract surgery and eyelid surgery: which one comes first

The short answer: there is no single rule, but the guiding principle is that the second operation should not undo the first; lid surgery can shift corneal measurements used to choose the lens implant, while cataract surgery can itself cause a droopy lid that sometimes improves on its own, so the order is decided by which problem is more pressing and whether a premium lens is planned.

Cataract surgery replaces the clouded natural lens with an artificial one. The power of that lens is calculated before surgery from measurements of the eye's length and the curvature of the cornea. Those calculations are remarkably precise, and they depend on a clean, stable ocular surface. The American Society of Cataract and Refractive Surgery's cornea committee published a pre-operative algorithm in 2019 urging surgeons to look for and treat ocular surface disease before taking measurements, because dry eye and lid disease can distort corneal readings and lead to a refractive surprise after the lens is in. Multifocal and extended depth of focus lenses, often called premium lenses, are especially unforgiving of a poor tear film, both in the measurements and in the quality of vision afterward.

That creates the case for doing eyelid surgery first. If a heavy lid is pressing on the cornea, or a lower lid is loose and the surface is chronically irritated, fixing the lids before measuring can give the cataract surgeon a truer reading. The tradeoff is time: the lids must heal and the corneal measurements must stabilize, which commonly means waiting a few months before cataract biometry. For someone whose cataract is mild and whose lids are the bigger complaint, that is a reasonable order.

There is an equally real case for doing cataract surgery first. A droopy upper lid after cataract surgery is a recognized complication, attributed to the speculum that holds the lids open, the anesthetic injection some surgeons use, and post-operative swelling and rubbing. A portion of these cases improve over the following months. An eyelid surgeon who operates on a lid shortly before cataract surgery may find the result altered by the cataract operation; one who operates shortly after may be correcting a droop that would have partly resolved. Many oculoplastic surgeons therefore prefer to wait several months after cataract surgery before repairing ptosis, so they are fixing the lid that is actually going to stay.

How the decision usually breaks down in practice:

• Cataract is limiting vision now. Cataract surgery tends to go first. Vision is the priority, and lid surgery can follow once the eye has settled.
• Lids are pressing on the cornea or the surface is unhealthy, and a premium lens is planned. Lid surgery or surface treatment often goes first, so measurements are taken on a stable cornea.
• Both are mild and elective. Either order can work. The deciding factor is often logistics: insurance coverage, the patient's calendar, and whether the two surgeons will coordinate.
• True ptosis rather than excess skin. Surgeons often favor finishing cataract surgery and waiting before ptosis repair, given the risk that the cataract operation changes lid height.

Insurance adds a layer. Cataract surgery is usually covered. Upper blepharoplasty or ptosis repair is sometimes covered when photographs and visual field testing document that the lids block vision, as described in the piece on insurance and medical necessity. Those visual field tests are normally done with the lids taped up and down, and a dense cataract can depress the readings and muddy the comparison. That is one more reason the ophthalmologist and the lid surgeon should agree on sequence before the testing is ordered.

Two other points. First, doing both operations on the same day is uncommon and generally discouraged, because it combines two sources of swelling, two sets of drops, and two healing timelines on one eye, and makes it hard to know which operation caused a problem; the piece on combining procedures covers that tradeoff more broadly. Second, a cataract surgeon who will later take measurements should get a copy of the eyelid operative note, and the eyelid surgeon should know what lens was placed and when. The piece on medical records after cosmetic surgery explains how to request them.

Glaucoma: drops, blebs, drainage tubes, and the hollowing nobody mentions

The short answer: glaucoma drops should usually be continued through eyelid surgery, the anesthesia team needs to know which ones are used because some act on the heart and lungs, a filtering bleb or drainage tube under the upper lid requires direct coordination with the glaucoma surgeon, and prostaglandin drops can hollow the upper lid in a way that changes what blepharoplasty should even try to do.

Glaucoma damages the optic nerve, usually in association with elevated pressure inside the eye, and treatment aims to lower that pressure. Most patients start with drops. Some go on to laser treatment, minimally invasive glaucoma surgery (often shortened to MIGS), or a traditional operation such as a trabeculectomy or a glaucoma drainage tube. Each of these leaves a fingerprint relevant to eyelid surgery.

The drops themselves. Glaucoma drops are not optional cosmetics, and stopping them for days around an elective operation can let pressure climb in an eye whose nerve is already damaged. The usual instruction is to keep using them on schedule, including the morning of surgery, unless the eye doctor and surgeon agree otherwise. They also belong on the medication list. Timolol and other beta blocker drops are absorbed into the bloodstream and can slow the heart rate and tighten the airways, which the anesthesia team wants to know, especially in patients with asthma or slow heart rhythms; the piece on anesthesia choice explains why the full list matters. Brimonidine can cause drowsiness and lower blood pressure. Oral acetazolamide, sometimes used for pressure spikes, can shift potassium and is a sulfonamide, which matters for allergy screening. Many glaucoma drops also contain the preservative benzalkonium chloride, which is hard on the ocular surface over years and contributes to the dry eye that lid surgery can unmask. Some patients can be switched to formulations without preservatives in the weeks before surgery; that is a conversation for the glaucoma doctor, not a decision for the patient to make alone.

Prostaglandin-associated periorbitopathy. Latanoprost, bimatoprost, travoprost, and related drops are among the most widely prescribed glaucoma medications. Over months to years they can shrink the fat around the eye, deepening the upper lid crease, making the upper lids look hollow, softening the lower lid bags, and in some patients pulling the eye back slightly in the socket. The piece on eyelash growth serums covers how the same drug class produces these changes in cosmetic users. For blepharoplasty, the implication is concrete: an upper lid that already looks hollow does not need fat removed, and removing more skin from a hollowed lid can make it look older and more skeletal, not younger. A surgeon who recognizes the pattern may recommend less, may discuss fat grafting or filler to restore volume, or may suggest asking the glaucoma doctor whether a different drug is possible, since the changes partly reverse in some patients after switching. A surgeon who does not recognize it may plan a standard operation for an atypical lid. The lower lid tells the same story in reverse: bags that appear smaller than expected may be smaller because of the drop, and stopping the drop could change the picture months after surgery.

Filtering blebs and drainage tubes. A trabeculectomy creates a new drainage channel that lets fluid escape from inside the eye into a small blister of conjunctiva, called a bleb, usually located at the top of the eye under the upper lid. Glaucoma drainage devices place a small tube into the eye and a plate on its surface, often in the upper outer quadrant, also under the lid. Both are delicate. A bleb is a thin, sometimes leaky barrier between the inside of the eye and the outside world, and bleb infection can progress to a serious infection inside the eye. An eyelid operation does not touch the bleb directly, but upper lid surgery is performed millimeters away, pressure patches and tight dressings can press on it, rubbing and swelling can irritate it, and ptosis repair in particular changes how the lid rides over it. Ptosis is also common after trabeculectomy, which brings these patients to the lid surgeon in the first place. The only safe approach is direct communication: the lid surgeon should know exactly where the bleb or tube sits, the glaucoma surgeon should agree to the plan, pressure dressings over the eye should be avoided or modified, and the patient should know the warning signs of bleb trouble, such as a red eye, discharge, pain, or blurring, and whom to call.

Advanced glaucoma and vision risk. The most feared complication of eyelid surgery is bleeding behind the eye, an orbital or retrobulbar hemorrhage, which can compress the optic nerve. It is rare; a frequently cited review in the journal Ophthalmic Plastic and Reconstructive Surgery estimated orbital hemorrhage at roughly 1 in 2,000 blepharoplasties and permanent vision loss at roughly 1 in 20,000 or fewer. For a patient whose optic nerve is already damaged by glaucoma, the margin is smaller. That argues for meticulous blood pressure and blood thinner management, covered in the piece on blood thinners before cosmetic surgery and the piece on high blood pressure before cosmetic surgery, and for a patient who knows that sudden severe eye pain, swelling that tightens the lids, or a drop in vision after surgery means an immediate call, not waiting for morning.

Planning the operation and the recovery around the eyes you actually have

The short answer: the plan should start with an eye exam rather than a mirror, involve a surgeon who will talk to the ophthalmologist, account for drops, lenses, and laser shields, and include a recovery routine that protects the tear film for longer than the bruising lasts.

A few things separate a coordinated plan from two surgeons working in parallel.

The right surgeon. Eyelid surgery is done by plastic surgeons, facial plastic surgeons, and oculoplastic surgeons, who are ophthalmologists with fellowship training in the lids and orbit. All three can do it well. A patient with prior LASIK, a planned cataract operation, or glaucoma surgery has a particular reason to ask how often the surgeon works alongside ophthalmologists and whether the practice performs its own tear film assessment. The piece on board certifications explains what the credentials mean, and a second consultation is worth the time when the two specialists give conflicting advice on sequence.

A full eye history on paper. Dates and types of refractive surgery, cataract surgery and the lens implanted, glaucoma diagnosis and surgery, prior eye injuries, and every drop by name. Operative notes help. The piece on pre-operative testing covers what else is genuinely useful before surgery and what is ritual.

The basic eyelid evaluation. Lid position, the strength of the lifting muscle, how tightly the lower lid holds against the eye, whether the eye closes completely, how the brows sit, and how much of what looks like excess lid skin is actually a descended brow, which the piece on lateral brow lift versus forehead lift discusses. This is the same evaluation the piece on blepharoplasty for sagging skin and under-eye bags describes, done with extra attention to the cornea.

Lasers and shields. Patients who combine eyelid surgery with laser resurfacing around the eyes, covered in the piece on ablative versus non-ablative lasers, often have metal or plastic shields placed directly on the eye during treatment. Those shields sit on the cornea. A patient with a LASIK flap, a recent cataract incision, or a bleb should make sure the laser provider knows before the shields go in.

The recovery routine. Swelling peaks in the first few days and fades over weeks, following the pattern in the piece on the swelling timeline. For eyes with a thin tear reserve, the routine that matters more than ice is lubrication: frequent artificial tears by day, a thicker ointment at night if the lids do not fully close, and sleeping with the head raised, as described in the piece on how to sleep after plastic surgery. Glaucoma drops continue on schedule, spaced several minutes apart from any new post-operative drops so one does not wash out the other. Rubbing is off limits, which is harder than it sounds for a patient whose eyes itch while healing. Contact lenses wait for clearance. Reading glasses may need a temporary loaner prescription if the patient normally wears lenses, and anyone just past cataract surgery may be between prescriptions entirely.

What should prompt a call. Severe or rising pain in the eye rather than the lid, sudden loss of vision, swelling that makes the lids tense and the eye bulge, a red eye with discharge in someone with a bleb or tube, or a cornea that feels gritty and painful and is getting worse rather than better. Ordinary bruising and puffiness, discussed in the piece on arnica and bromelain for bruising, are expected; changes in vision and pain inside the eye are not.

Finally, expectations. A patient who has spent years managing dry eye after LASIK or using drops for glaucoma may still be an excellent candidate for eyelid surgery, with lids that look rested and fields of vision that open up. What the operation cannot do is repair the tear film, regrow corneal nerves, or replace the conversation between the eye doctor and the lid surgeon. Patients who expect it to do those things are the ones who end up unhappy at six months, with lids that look right and eyes that feel wrong.

The honest summary

Eyelid surgery, laser vision correction, cataract surgery, and glaucoma treatment all act on the same small system: a thin tear film, a sensitive cornea, and the lids that spread and protect both. That is why blepharoplasty after LASIK needs a measured tear assessment and a conservative plan, why lid surgery generally goes before any planned laser vision correction, and why the order of cataract and eyelid surgery depends on whether the cataract is limiting vision now, whether a premium lens is planned, and whether the lid problem is excess skin or true ptosis that cataract surgery might change.

Glaucoma adds its own considerations. Drops usually continue through surgery and belong on the medication list, since some affect the heart and lungs. Prostaglandin drops can hollow the upper lids and soften lower lid bags, which should change what a blepharoplasty sets out to remove. A filtering bleb or drainage tube under the upper lid calls for direct coordination with the glaucoma surgeon and a dressing plan that keeps pressure off the eye. And because the rare but serious complication of eyelid surgery is bleeding that threatens the optic nerve, patients whose nerves are already damaged have the strongest reason to manage blood pressure and blood thinners carefully and to know which symptoms mean an immediate call.

None of this argues against eyelid surgery for people with complicated eyes. It argues for putting every eye operation and every drop on paper, choosing a lid surgeon who examines the tear film and talks to the ophthalmologist, letting the two specialists agree on the order before either sets a date, and treating lubrication as part of the recovery for months rather than days. The patient is often the only person who knows that all of these operations are coming. Making sure the surgeons know too is the single most useful thing a patient can do.