eMedicine Specialties > Ophthalmology > Lid

Dermatochalasis: Follow-up

Author: Grant D Gilliland, MD, Private Practice, Texas Ophthalmic Plastic, Reconstructive and Orbital Surgery Associates
Contributor Information and Disclosures

Updated: Nov 2, 2007

Follow-up

Inpatient & Outpatient Medications

  • Topical antibiotics and lubrication of the cornea are indicated postoperatively.
  • Most patients 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.

Deterrence/Prevention

  • Smoking and eyelid rubbing should be avoided.

Complications

  • Lagophthalmos
    • 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
    • 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.
  • 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.
  • Ptosis
    • 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
    • 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
    • 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.
  • Blindness
    • 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.

Prognosis

  • The prognosis is excellent with blepharoplasty surgery.

Miscellaneous

Medicolegal Pitfalls

  • Blindness is a rare and devastating complication. In most cases, this complication can be prevented by prompt recognition and emergent canthotomy and orbital decompression.
  • Dry eye is the most common complication after blepharoplasty. It is imperative that a careful history and eye examination be performed preoperatively.
    • Unrecognized dry eye, lagophthalmos, poor Bell phenomenon, and eyelid deformity can lead to significant ocular complications.
    • It is impossible to ensure that patients will not experience worsening of their dry eye after blepharoplasty despite careful preoperative evaluation and judicious surgery.
  • Eyelid retraction occurs in a small percentage of patients despite judicious surgery and preoperative evaluation. Prompt and aggressive treatment can alleviate the symptoms of most patients.
  • A change in the refraction averages approximately 0.6 diopters 3 months after blepharoplasty. A transient diopteric change greater than 1.00 diopter is experienced by 11% of patients.
  • LASIK surgery and blepharoplasty surgery are both known to be factors in dry eye symptoms. Therefore, waiting a minimum of 6 months after LASIK surgery before performing blepharoplasty surgery is important, as this allows enough time for resolution of the post-LASIK dry eye and maturation of the LASIK wound.3
 


More on Dermatochalasis

Overview: Dermatochalasis
Differential Diagnoses & Workup: Dermatochalasis
Treatment & Medication: Dermatochalasis
Follow-up: Dermatochalasis
Multimedia: Dermatochalasis
References
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Further Reading

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Keywords

blepharochalasis, steatoblepharon, blepharitis, blepharoplasty, eyelid surgery, eyelid tissue, eyelid skin, redundant skin, lax eyelid skin, eyelid laxity, epidermis thinning, skin redundancy, visual field loss, visual field defect

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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.

Medical Editor

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 Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, 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 Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

CME Editor

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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