Patient Suffers Partial Vision Loss and Eyelid Retraction After Blepharoplasty

This case involves a male patient who presented to his plastic surgeon for a consultation regarding his eyelids. Upon examination, the physician noted bilateral ptosis (drooping of the eyelid). After evaluation by the plastic surgeon, he recommended the patient undergo bilateral upper lid blepharoplasty and levator resection. The patient later developed right upper lid retraction with lagophthalmos. A repeat procedure had to be conducted, which did not correct the asymmetry. The patient is now left with uneven eyelids and inability to close the right eye completely. Additionally, he has decreased vision in his right eye.

Question(s) For Expert Witness

1. Are the above complications (blindness and lid retraction) avoidable during blepharoplasty?

Expert Witness Response

Surgeons performing blepharoplasty should be aware of the dry eye syndrome, since elective surgery on the eyelids can mechanically alter the anatomy sufficiently to aggravate a subclinical condition, resulting in full-blown keratoconjunctivitis sicca. This may occur due to interruption of the neural innervations of the glands of the lids that provide basal stimulation and to the possibility of exposure keratitis. Additionally, the surgeon can remove excessive skin from the eyelids leading to retraction, and potentially vision loss due to keratoconjunctivitis.