Double Vision After Blepharoplasty

Question

I had a upper and lower blepharoplasty with a right eye ptosis repair all at the same time. I have notice that my right eye, besides not opening all the way also has double vision. Will this resolve or do I need to see an ophthalmologist?

Kenneth D. Steinsapir, MD · Answer

It may surprise you to learn that most non-ophthalmologist eyelid surgeons have very uneven skill in repairing eyelid ptosis.  Some might even argue that this is an overly generous characterization.  However, upper eyelid surgery often needs revision and heaviness after ptosis surgery is the principle reason for this even the hands of the best ptosis surgeons.  However, double vision following this type of eyelid surgery is a whole other kettle of fish.  This is much more concerning.  It is a most untypical issue.  

	Depending on the exact cause of the issue, it might resolve on its own or it might require surgical intervention.  An ophthalmologist can measure double vision very precisely.  By repeating these measurements, it is possible to determine if there is sufficient improvement to venture a guess that it might resolve on its own without intervention.  Please do not just go to any ophthalmologist for this assessment.  You should be seen by an expert whose area is oculoplastic surgery.  You live in Upland and it is possible you could find an appropriate expert at Loma Linda however, I would encourage you to seek out help at USC or UCLA.  I am on Staff at UCLA so I am admittedly biased but if I was having this type of issue, I would seek help at the Jules Stein Eye Institute.

William Portuese, MD · Answer

If you have double vision after blepharoplasty, see your ophthalmologist or oculoplastic surgeon to determine the cause. It is unlikely to resolve on it&rsquo;s own.

Joseph A. Eviatar, MD, FACS · Answer

Double vision immediately after blepharoplasty is common due to the anesthetic around the eyelids. If it lasts for more than a day, it may be associated with trauma to one of the eye muscles. Often double vision will get better on its own, but rarely may require other treatment.

Steven Wallach, MD · Answer

Hard to say what is wrong without a formal exam, pictures, etc.. A good history in terms of timing of the surgery and what exactly was done would be helpful. Sometimes post-op, patients have double vision that improves after eye lubrication returns to normal.

Peter A. Aldea, MD · Answer

Without seeing your Before / After photographs, I cannot comment on your not being able to open your eye "all the way". This can be a poor or relapsed repair of your sagging upper lid (Ptosis) OR may be associated with a Facial nerve branch injury.

	Seeing double (Diplopia) is never normal. It  is caused by the inability of both eyes to look at an object the same way usually due to loss of coordination of the extra-ocular muscles (muscles outside the eye). The most common cause may be swelling or injury to the inferior oblique muscle or its pulley. This is especially worse when trying to look down.

	You need to see your surgeon.

Marcus L. Peterson, MD · Answer

There are a couple of reason to have double vision after upper and lower lid blepharoplasty.  Does it occur all the time or is it noted only when looking in certain directions?  This will help determine the cause of the double vision.

	If you had a ptosis repair on the right side and it is still too low you should see your surgeon and go over this and the double vision issue.  The best person to help you right now is your original surgeon.

Philip Young, MD · Answer

Double Vision should be seen by your doctor after Blepharoplasty as well as by an ophthomologist.  There could be many reasons for this.  It does depend on the timing after the procedure.  If it is the day of your procedure or the day after, this could be from the swelling and local anesthesia.  Sometimes local anesthesia can have longer affects on the eye muscles. Swelling can also affect the way the eye is positioned so that there is double vision.  The key difference is whether the double vision is from the way both eyes are positioned meaning that when one eye is looking based on one position and the other eye is looking based on another different position. 

	This can be due to swelling and the eye muscles being temporarily weakened.  Sometimes it is due to muscle damage that can occur with upper and lower eyelid blepharoplasty.  This can resolve on its own over several months.  But could require eye muscle surgery that must be done by a qualified ophthomologist.  If it is double vision only when the one affected eye is open then it could be due to something related to the lens of that one eye.  Sometimes through blepharoplasty the changes brought about changing the eyelid skin leads to differential pressures to the lens that can lead to visual changes that can be interpreted as double vision.  This issue can also be followed by your doctor or ophthomologist as well.

Double Vision After Blepharoplasty

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