Dermatochalasis Follow-up

Updated: Feb 22, 2017
  • Author: Grant D Gilliland, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Follow-up

Inpatient & Outpatient Medications

Topical antibiotics and lubrication of the cornea are indicated postoperatively.

Some patients may have lagophthalmos in the first week after surgery. Artificial tears can be prescribed with nocturnal lubricating ointment to prevent corneal exposure.

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Deterrence/Prevention

Smoking and eyelid rubbing should be avoided.

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Complications

Lagophthalmos in dermatochalasis

Lagophthalmos can occur if overzealous 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 of the eyelid shut at night, punctal plugs, spectacles, or moisture chamber.

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. [15, 16] 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. [17]

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

This usually resolves spontaneously in a few weeks but may persist for months. [18, 19]

Treatment consists of sleeping with the head of the bed up, 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. [20]

The incidence has been reported as high as 26% and is more common in patients undergoing concurrent upper and lower blepharoplasty. [21]

Blindness in dermatochalasis

Blindness is a rare but devastating complication of blepharoplasty surgery. [22, 23]

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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