Dermatochalasis Follow-up

  • Author: Grant D Gilliland, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 27, 2012
 

Inpatient & Outpatient Medications

Topical antibiotics and lubrication of the cornea are indicated postoperatively.

Most patients with dermatochalasis have difficulty in closing their eyes fully in the first week after surgery. For this reason, topical erythromycin ointment is used to keep the cornea moist at night.

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Deterrence/Prevention

Smoking and eyelid rubbing should be avoided.

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Complications

Lagophthalmos in dermatochalasis

  • Lagophthalmos can be a potentially serious complication if overjudicious resection of the skin and/or muscle is performed or if the orbital septum is incorporated into the wound closure or undergoes excessive scar contraction.
  • Some patients may have lagophthalmos prior to surgery. It is unlikely that resection of a small amount of preseptal orbicularis oculi causes lagophthalmos or dry eye.

Keratitis in dermatochalasis

  • Keratitis can be a potentially serious complication. This is most commonly due to lagophthalmos but can occur in its absence. It is imperative that patients be evaluated preoperatively for dry eye.
  • Dry eye is treated with topical lubricants, taping the eyelid shut at night, and punctal plugs.

Scarring is rarely a significant problem after blepharoplasty. If hypertrophic scarring develops, it is treated with topical steroid ointment, massage, and silicone gel.

Corneal topography may change after upper eyelid blepharoplasty surgery. With a skin-only excision, minimal astigmatic changes are noted.[10, 11] However, with removal of large fat pads, corneal astigmatism has been shown to change approximately 0.2 diopters.

Diplopia is very rare after blepharoplasty and occurs most commonly after lower eyelid blepharoplasty. In most cases, it is due to injury to the inferior oblique or inferior rectus muscle; rarely, the lateral rectus muscle can be injured.[12]

  • Ptosis in dermatochalasis
    • Ptosis is a rare complication of upper eyelid blepharoplasty. It is imperative that ptosis be ruled out prior to surgery.
    • In most cases, ptosis is due to prolonged eyelid edema with dehiscence of the levator aponeurosis or injury to the levator aponeurosis.
  • Eyelid retraction in dermatochalasis
    • Eyelid retraction is the most common complication after lower eyelid blepharoplasty. The incidence of this complication after transconjunctival blepharoplasty is approximately 0.5%, and, after subciliary blepharoplasty, it is 3-5%.
    • The treatment is directed initially at massaging the lower eyelid. Subcutaneous steroid injection can be considered.
    • If the retraction persists despite aggressive massage, canthopexy, tissue grafts (eg, skin, hard palate, Alloderm, ear cartilage), and cheek elevation may be indicated.
  • Conjunctival chemosis in dermatochalasis[13, 14]
    • This usually resolves spontaneously in a few weeks but may persist for months.
    • Treatment consists of topical lubrication and topical steroids.
    • If chemosis persists, conjunctival incision and temporary tarsorrhaphy may be considered.
    • For chronic chemosis, subconjunctival injection of tetracycline 2% may be useful.[15]
  • Blindness in dermatochalasis[16, 17]
    • Blindness is a rare but devastating complication of blepharoplasty surgery.
    • In most documented cases, blindness results from retrobulbar hemorrhage with resultant optic nerve and vascular compression.
    • Central retinal artery occlusion has also been documented as a cause of blindness after blepharoplasty.
    • If orbital hemorrhage occurs, emergent canthotomy and orbital decompression should be performed.
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Prognosis

The prognosis is excellent with blepharoplasty surgery.

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Contributor Information and Disclosures
Author

Grant D Gilliland, MD  Private Practice, Texas Ophthalmic Plastic, Reconstructive and Orbital Surgery Associates

Grant D Gilliland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Ron W Pelton, MD, PhD  Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Preoperative image prior to upper blepharoplasty.
Postoperative image after upper blepharoplasty.
Preoperative image of a patient with thyroid eye disease, dermatochalasis, eyelid retraction, and steatoblepharon.
Postoperative image after 4-lid blepharoplasty and canthopexy.
Pinch technique for measuring redundant skin in upper eyelid blepharoplasty.
 
 
 
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