Fleshy Strip on Eyeball After Lower Transconjuctival Blepharoplasty. Limiting Eye Movement/causing Double Vision? (photo)

24 days post lower transconjuctival blepharoplasty. I'm really scared. Right eye: I have double vision when I look to the left, down or upward. Muscle (?) around eye feels tight when I do. Surgeon says she 'thinks' it will improve & doesn't think it's muscle damage but no explanation. There is a fleshy “strip” at the bottom of my eyeball that is not present on the other eye. Can anybody tell me what this could be? My surgeon does not seem to know. Checks me weekly. Has me on steroid drops.

Doctor Answers 9

Double vision after transconj blepharoplasty

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  Certainly, double vision is not an expected finding after transconjunctival blepharoplasty.  BUT there is a big difference between double vision that occurs when using both eyes and double vision that occurs in just your right eye as you report.  I do think you should see an ophthalmologist or oculofacial surgeon for evaluation of your double vision.  But chances are certainly in your favor that things will improve with time.

Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 140 reviews

Seek a second opinion

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This is certainly not a common result after blepharoplasty. The lower eyelid fat is adjacent to muscles that move the eye and possibly the muscle may have been bruised, or possibly damaged during surgery.

Your surgeon is likely correct that this will improve with time. The last thing that you want to do is jump back in and have surgery again very early. I would recommend evaluation by an Oculoplastic surgeon, or even a Pediatric ophthalmologist [they deal with double vision most commonly] so that they can measure exactly the amount of double vision and monitor progression.

The "fleshy strip" is just  swelling of the conjunctiva, the 'skin' of the eyeball. It is quite common and will improve with time.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Eye problem after blepharoplasty

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It is difficult to assess your problem without close examination. What you are describing can be transient and improve with time but it may not depending on the exact problem.  Consider consult with an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Double vision and swelling after blepharoplasty

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The "fleshy strip" inside the eyelid is most likely a swollen conjunctiva around the incision line, called chemosis.  This should resolve with time, and steroid eye drops help to speed up the resolution.

Double vision is uncommon after blepharoplasty and is usually related to muscle deficit whether due to trauma/ swelling or direct injury (muscle being cut). If former, then the condition should improve as muscle returns to normal state.  If muscle is interrupted, the diplopia is likely to persist and will require a surgical correction.  In any case, I would definitely continue a close follow up with your surgeon -- it is too early to lose the trust. You may get a second opinion with an occuloplastic surgeon to make sure you are on the right track.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 32 reviews

Fleshy Strip on Eyeball After Lower Transconjuctival Blepharoplasty. Limiting Eye Movement/causing Double Vision?

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 This is called chemosis and is swelling of the conjunctival covering that continues onto the lower eyelid.  This can swell with a transconjunctival lower eyelid surgery because the incision is placed inside the lower eyelid.  Double vision and visual changes have been reported with eyelid surgery.  These are typically transient and resolve in several weeks however, you might ask for a referral to an ophthalmologist to treat the chemosis as well as the visual change.  The chemosis can be drained with a small local office procedure.

IMHO, it's not a good idea for you to be pulling the lower eyelid as you did in the enclosed photo...this adds trauma to the area and could contribute to the chemosis not resolving. 

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Double vision more than a day after lower eyelid surgery is concerning and unusual!

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During transconjunctival lower blepharoplasty it is possible to have direct damage to the inferior oblique muscle or restriction due to scaring after surgery.  When these are mild, they gradually improve after surgery.  An oculoplastic surgeon or pediatric ophthalmologist can exactly measure the double vision and know how the condition is progressing or improving.  Sequential improvement from visit to visit is used to document progress.  Double vision that does not resolve may or may not require extra ocular muscle surgery.  Much depends on the degree of double vision and in what positions it is experienced.  If you experience no double vision for distance vision or reading and only have an issue in far extreme gaze, it is often not worth while having this type of issue addressed surgically.  Often a small bit of double vision after blepharoplasty like this will resolve over several months time.  The key is getting a second opinion and being followed by a specialist who knows how to measure and follow double vision.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Double vision after blepharoplasty

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It is not usual to have double vision after eyelid surgery. Since it has not resolved after several weeks, it would be worthwhile seeing an ophthalmologist for an eye exam and second opinion. 

Joseph Mele, MD
Walnut Creek Plastic Surgeon
4.5 out of 5 stars 17 reviews

Transconjunctival Blepharoplasty and Double Vision

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The symptoms you are reporting are abnormal in a patient who has had a transconjunctival lower lid Blepharoplasty.  I recommend that you see an Occuloplastic Surgeon right away and discuss your situation.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Transconjunctival blepharoplasty with double vision.

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Transconjunctival blepharoplasty with double vision is not normal and it would be best for you to see and ophthamologist for a second opinion.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 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.