Upper Eyelid Blepharoplasty: One Eye Wont Open? (photo)

Question

Five days after surgery, I have one eye that will not open more than half way. One eye feels great in recovery (with no loss of muscle control or feeling) while the other has felt completely numb and paralyzed. It closes fine but I have not been able to open the eye more than half way. I'm not seeing the "inability to fully open one eye" as a common problem after upper eyelid surgery. What causes this kind of complication? What are the chances it may not open again without corrective surgery?

Kenneth D. Steinsapir, MD · Answer

Injuring the levator palpebra superioris muscle in blepharoplasty surgery is rare. Accidently sewing the movable levator to the orbital septum not so uncommon. When this is done the eyelid is no longer free to open all the way. The real test here would be if the right upper eyelid hangs up in down gaze compared to the left side. This can't be determined by the photos you provided. I recommend seeing an academic oculoplastic surgeon such as Don Kikkawa, M.D. or Bobby Korn M.D. at UC San Diego Shiley Eye Center. They can see you and immediately determine if something serious is going on or otherwise reassure you so you can continue to be taken care by your plastic surgeon. Explain your situation to their intake person and ask for an urgent appointment.

John Bitner, MD · Answer

The muscle responsible for opening the upper eyelid is called the levator palpebrae (usually called just the levator). It attaches to the upper eyelid immediately deep to the skin removed with an upper blepharoplasty. This could be a temporary result of the local anesthesia, swelling of the muscle, or accidental detachment of the muscle from the eyelid. The first two conditions should resolve on their own within a couple days or weeks. The third possibility would need to be surgically repaired. Hope that helps.

Vincent N. Zubowicz, MD · Answer

Inability to completely close the eyes or other functional eyelid disturbances are sometimes seen after blepharoplasty. These will resolve in time.

Kenneth Hughes, MD · Answer

You are still extremely swollen and bruised, and this may be placing enough physical constraint on the upper eyelid to prevent opening. Inability to fully open upper eyelid as a permanent result would be much less than 1%.

Michael I. Echavez, MD · Answer

At five days after your surgery, there is still a significant amount of swelling present. It does appear as if there may be more swelling on one side than the other, and this could cause you to not be able to open that eye fully. I would definitely give it some more time to heal and to allow the swelling to dissipate and then you will have a much better idea of how your eyes will look and function. Be sure to keep your follow up appointments with your surgeon so that your progress can be evaluated.

Darryl J. Blinski, MD · Answer

Best case scenario it is edema in the lid so further healing time will alleviate. Or you have lag opthalmus condition that self corrects in a few months, ask your surgeon. Or a worst case scenario is damage to the levitator superiors function, again discuss with your surgeon. Better yet obtain eye doctor evaluation.

Upper Eyelid Blepharoplasty: One Eye Wont Open? (photo)

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