Lower blepharoplasty eye protection during surgery?

Question

Hi! I've seen surgeons disagree on the topic of eye protection during blepharoplasty procedures. Some say it's safer because it protects the eye. Others say it can damage the eye, and if the eye is covered up, the surgeon cannot see if anything is going wrong during surgery. Opinions? I also was wondering why some surgeons only do general anesthesia for a lower bleph, some twilight, and some only local! Seems like it wouldn't be safe for the patient to move at all , especially for such a delicate and specific area? Thanks!

Anshu Gupta, MD · Answer

Eye Protection During Blepharoplasty:Some surgeons use a plastic eye shield during lower blepharoplasty to protect the eyeball, but it does limit visibility. Performing the procedure without it can offer greater precision, and in experienced hands, the risk of eye injury is very low. In the rare event of a minor injury, the eye typically heals on its own. Personally, I do believe in using eye protection, but we remove it at the final stage of the procedure to allow for full visibility during the most delicate parts of the repair.
Anesthesia Choices:Regarding anesthesia, our preference is general anesthesia for the exact reason you mentioned: to prevent any patient movement during such a delicate procedure and to ensure maximum comfort. There is one particular maneuver&mdash;detaching the lower eyelid from the cheekbone&mdash;that can be quite uncomfortable under local anesthesia. Some surgeons who perform the procedure under local may skip this step, which can compromise the quality of the result. Ideally, for the most thorough and effective lower blepharoplasty, all critical steps should be performed, and general anesthesia allows for that without concern about patient movement or discomfort.

Gary M. Horndeski, MD · Answer

I routinely use globe protectors during blepharoplasty surgery and I always perform them under general anesthesia so the patient does not move. I have never had any complications using globe protectors.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Jeffrey M. Darrow, MD · Answer

if your lower eyelid surgery is being done with an incision on the outside skin, the lower eyelid is usually held up and over the eyeball with a suture, and therefore protects the eye. If you’re using the trans conjunctival incision, which is an incision on the inside of the eyelid, eye protectors are prudent to use to protect the eye.  A combination of eyelid lubrication and eyeball protector is very safe and should not damage the eye.  You are correct that different surgeons use different types of anesthesia for lower eyelids. I have always felt that my patients have the very best experience with lower eyelid surgery if they are asleep and don’t have to worry about moving during surgery.  Best wishes.

Eric M. Joseph, MD · Answer

When people have under eye bulging fat pads, we typically remove them through an incision on the inside of the eyelid. The globe, or eyeball, is always protected. In our experience, after the lower eyelid incision is made, the back portion of the flap is retracted upward, with a suture, to protect the eyeball. I do agree that performing transconjunctival lower blepharoplasty would likely require twilight anesthesia, or general anesthesia, for patient comfort. I also agree that some surgeons utilize a topical numbing anesthetic in the eye, along with local anesthetic, however, we have not tried this in our practice. Thank you for this question! Sincerely, Dr Joseph

Kenneth D. Steinsapir, MD · Answer

I am a fellowship trained Oculoplastic surgeon and board certified ophthalmologist. I am trained to work very close to the eye without injuring it. Plastic surgeons, facial plastic surgeons, and other types of surgeons do not have similar training and skills to work close to the eye. Generally all types of surgeons should employ strategies for protecting the eye. When I work on the upper eyelid, lateral canthus, or performing transcutaneous lower eyelid surgery, whenever possible, I place a metal shield on the eye surface. When performing transconjunctival lower eyelid surgery, a specialized retractor is used to protect the corneal surface.

Regarding anesthesia, general anesthesia is unnecessary. It is often performed as a convenience to the operating surgeon by eliminating to possible need to speak with the patient. Straight local anesthesia even with oral sedation is often less than ideal. This is generally advocated by surgeon using unaccredited exam rooms for performing surgery. Intravenous sedation with local anesthetic is probably the best balance of patient comfort and surgeon control. However this requires an accredited operating room environment.

William Portuese, MD · Answer

In our practice, we perform eye protection during a lower eyelid surgery procedure. It's also important to make sure patients don't rub their eyes in the recovery room and scratch their cornea as well. Regarding lower eyelid surgery, we place the incision on the inside of the lower lid to remove the fat bags, that are creating the puffy look. For patients who have excess skin and over 50 years of age, then we will perform a pinch technique removal of a small amount of excess skin on the lower lids when necessary. We close this incision with tissue glue. We perform all lower eyelid surgical procedures under general anesthesia for patient safety and comfort, since it would be too painful during the procedure to perform this under local anesthesia. The upper eyelids can certainly be performed quite easily under local anesthesia, just not lower eyelid surgery.

Lower blepharoplasty eye protection during surgery?

Answers (6)

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