Can You Go Blind with Blepharoplasty?

Doctor Answers (14)

Complications with Blepharoplasty

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In my per 35 years of experience in practice I have never seen a complication of blindness. It is something that is listed on all consents and is known by most qualified surgeons to be a possible however extremely rare complication of eyelid surgery. It is a complication of postoperative bleeding where pressure builds up and effects the retina and optic nerve possibly causing impairment of vision. Again with good surgical skills, controlling all bleeding during the procedure, proper pre and post operative care and follow up this is an extremely rare occurring complication.


Orange County Facial Plastic Surgeon
5.0 out of 5 stars 124 reviews

Excessive bleeding is the potential and very rare risk of blindness following blepharoplasty

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The cases of blindness following blepharoplasty or eyelid plastic surgery are so rare that one author has reported the occurance in about 1 in 800,000 cases.

The risk of bleeding is highest in the first 3 hours after surgery, so monitoring in the recovery area for the first 3 hours eliminates most of the risk that unrecognized bleeding has occcurred.

If bleeding is detected early, the bleeding can be stopped and any risk to vision corrected if necessary by procedures designed to remove acccumulated blood and take pressure off the eye.

Hundreds of thousands of blepharoplasty are done safely each year. The key is having your blepharoplasty done by an expert in a safe medical environment and careful monitoring for the first 3 hours after surgery.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 26 reviews

Blindness from blepharoplasty is extremely rare

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Blindness after a blepharoplasty is an extremely rare complication that can occur from bleeding or infection. Both of those incidences are extremely rare, and we have never seen them in private practice.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

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Blepharoplasty and Blindness

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You can. This is a well know risk and complication, although very rare. This procedure may be rather simple but it does have its devasting complications just like any other plastic surgery procedures. There are things that we do in the operating room to prevent this and there are things that we can do to treat this as well. Patients that have a history of high blood pressure that is not well controlled are at greater risk.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 31 reviews

Blindness is a potential Blepharoplasty complication

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Yes. You can. Blindness associated with Blepharoplasty is a recognized potential complication of Blepharoplasty which happens to be among the rarest of all its complications.

EVERY board certified Plastic surgeon is aware of this complication and of its most common cause - bleeding around the eyeball putting pressure on the back of the eye (IE retrobulbar hematoma) and how to prevent and treat it. It is a favorite question on board examination.

Personally, I have NEVER seen one nor do I know of a colleague who can say he/she saw one. So while it is possible, it is very rare AND we all know what it looks like and how to deal with it SHOULD it manifests itself. So, don't worry.

I hope this answered your question.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 58 reviews

Extremely rare to go blind from Blepharoplasty

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This is a very rare complication that could occur due to bleeding inside the eye cone. Increased pressure from the bleeding leads to obstruction of the blood supply to the optic nerve. All board certified plastic surgeons are well trained on ways to prevent this complication and how to treat it very quickly if it happens.

Best of luck!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 4 reviews

Yes, but fortunately it is a very rare complication.

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Excessive bleeding into the eye after lower eyelid surgery may result in blindness. This is because the bleeding into the eye causes so much pressure that the normal blood flow to the eye cannot get through and blindness may result. Fortunately, this is an extremely rare complication . Well-trained eyelid surgeons know of this complication and meticulously control bleeding during surgery. Postoperatively patients are asked to use ice compresses and not to exert themselves, so as not to cause any unexpected bleeding. During the informed consent process, the physician will mention that blindness is a risk, but luckily, it is very unlikely to occur.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Absolutely, blindness from Blepharoplasty is a rare but real risk

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Dear Cherri

The risk of blindness associated with blepharoplasty would primarily be from uncontrolled bleeding behind the eyelid after surgery. The expanding pool of blood in the confined space around the eye raises the pressure to the point where the circulation of blood to the retina is effected resulting in loss of vision. This process is called a retrobulbar hemorrhage. It is rare. One doctor here quotes a figure of 1 in 10,000 cases. This figure seems high. That would mean that last year, about 20 people would have gone blind from their blepharoplasty. That many cases would be big news.

I have also seen the figure of 1:300,000 and I think that number is too low. So some where in between is probably about right. This makes it a rare event.

The problem with rare events is that doctors begin to think it won't happen to them. So if someone tells you they have done X numbers of eyelid surgeries and have never seen it, it really means that have not seen enough cases.

How do oculoplastic surgeons manage this risk? First we have our patients avoid medications that thin the blood. This includes medications like Aspirin, Ibuprofen the active ingredient in Advil and Motrin, and almost all herbal products.

There are technical steps in surgery that reduce the risk of post-operative hemorrhage. Patients are also instructed to rest in bed after surgery and call immediately for bleeding, pain, or visional reduction after surgery.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Blindness after Blepharoplasty

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Yes.

It is rare in the upper eyelid blepharoplasty but has been reported in lower eyelid blepharoplasty. Typically happens from bleeding inside the fatty tissue of the lower eyelid. If not addressed immediately then pressure from the accumulating blood can cause permanent damage to the optic (eye) nerve causing blindness. Other causes like infection, corneal injury etc are very rare.

So, make sure you are off all the medicine that can make you bleed. Better yet, read my instructions below.

Regards.

2345 Lamington Rd, Ste 108
Bedminster, NJ 07921
Tel: (908) 470-2600 Fax: (908) 470-1660 www.janjuafacialsurgery.com

INSTRUCTIONS FOR PATIENTS UNDERGOING BLEPHAROPLASTY

BEFORE SURGERY:

• Please read the general surgical instruction sheet given to you.
• You will be given a prescription for Tobradex eye drops and Bacitracin eye ointment.
• If you have any problems or concerns about your eyes or vision please let me know. I am especially interested in any symptoms of dry eyes, excessive tearing, double vision, thyroid disease, diabetes, glaucoma, injury to the eyes or any past surgery on the eyes.
• Please take a closer look at your eyes in the mirror. Most people have some asymmetry in the position of the eyebrows and at times the eyelids. These can be corrected to some extent but will not be identical in position and shape after surgery. Also the eyelid skin can be lighter closer to the lash line but darker in the area away from the lashes. If you have this it will not change after surgery.
• Blepharoplasty is a rewarding procedure and improves the aesthetic appearance of the whole face. In particular it makes a person appear younger. However, it carries risks including bleeding, infection, changes in vision such as double vision, blindness, dry eyes, droopy eyelid, insufficient skin removal or excess removal leading to incomplete eye closure, hollow appearance of the eyes because of excessive fat removal, prolonged swelling of the eyes or asymmetry of the eyes. The most devastating complication is loss of vision. The chance of this complication happening is approximately 0.04%. It usually happens because of bleeding in the eye after surgery. In most cases if the problem is identified early enough, treatment can reverse the loss of vision. The best way to prevent this complication is to avoid any Alcohol, Aspirin, Motrin, Ibuprofen, Advil, Excedrin, Vitamin-E, Multiviatmins (they contain Vitamin-E), Gingko Beloba, fish oil or other herbs, Garlique, or any other blood thinners before surgery. For headaches or pain Tylenol is safe to take. It is crucial to avoid any physical exertion for two weeks after surgery. Blowing your nose, sneezing, coughing, straining in the bathroom, lifting weights, bending over can increase the chances of bleeding. If you need medication for constipation, cough or allergies causing sneezing, please let me know.
• Bring dark sunglasses with you to the hospital or the office.
• Buy or loan some books on audio cassettes from the library to listen to after your surgery for the first night.
• You will need to arrange for an adult to provide a ride to take you home from after surgery and preferably spend the night with you after surgery.

AFTER SURGERY:

• Applying icepacks to the eyes for the first three days after your surgery is important. Use alcohol in a ziplock bag. It will not become solid in the freezer and will be easy to apply to the eyes. An alternative is to put frozen peas in a ziplock bag.
• Do not wear contacts for three days after surgery.
• Do not exercise or attempt to do house work. Do not bend over, push or lift any thing heavy.
• Sleep with your head elevated on two pillows or in a recliner.
• Do not strain your eyes by watching TV or reading a book for at least two days. You can listen to music.
• Clean the incisions with cotton tip applicator (Q-tips) and hydrogen peroxide, at least three times a day. Then apply Bacitracin ophthalmic ointment on the incisions. Do not let the incisions become dry.
• Put two drops of Tobradex eye drops in each eye twice a day for five days.
• Systane eye drops (over the counter) can be used to help with the itching.
• Do not wash your eyes for five days. Clean the rest of your face with a wash cloth.
• You will return to the office in three to five days for removal of the stitches.
• Do not drink alcohol for two weeks.
• For pain take Tylenol or the prescription pain medication given to you.
• DO NOT TAKE ASPIRIN
• IF AT ANY TIME YOUR VISION CHANGES, THE EYE BECOMES SWOLLEN OR RED, OR YOU HAVE INCREASING PAIN, PLEASE CALL ME IMMEDIATELY.

YOUR NOTES AND QUESTIONS:

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Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Blindness after blepharoplasty

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This is a very rare complication. The usual cause is bleeding that goes unrecognized or a disease that occurs concurrent or as a coincidence such as a retinal artery occlusion, temporal arteritis or stroke. Since you are concerned discuss this with your plastic surgeon to allay any fears you may have. Good luck with your surgery!

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.