In this prospective, comparative case series, the authors compare the effect of combined blepharoplasty and Muller muscle conjunctival resection (MMCR) to an upper blepharoplasty in dry eye syndrome. The study was approved by the local institutional review board and participants provided informed consent. Adults with dermatochalasis were included in blepharoplasty group and those with ptosis and dermatochalasis were in ptosis group. Patients with history of dry eyes, contact lens use, ocular and orbital surgery and patients with corneal surface altering diseases were excluded. Ptosis evaluation included MRD1 and 10% phenylephrine tests. All patients had subjective and objective dry eye evaluation. They underwent a baseline evaluation before the procedure and then on postoperative days one, seven, 30 and 90 days. Subjective evaluation was carried out to include a questionnaire with three subscales: ocular symptoms, vision-related function and environmental triggers. Responses were noted on a scale of 0 (never) to 4 (all the time). Objective evaluation included the Schirmer test 2, tear film break-up time (TBUT), fluorescein staining and Lissamine green staining. There were 23 patients in the blepharoplasty group and 31 patients in the ptosis group. There were significant increases in postoperative LG scores and in fluorescein staining post ptosis surgery compared with the pre-op values. Postoperative Ocular Surface Index Score was significantly higher post-surgery compared to preoperative score in the ptosis group. There was no significant difference between the postoperative and preoperative objective and subjective tests in the blepharoplasty group. The authors conclude that MMCR causes an increase in subjective and objective signs of dry eyes.