Risk of Eyelid Surgery Causing Permanent Blindness or Double Vision

There is no procedure without risk.  In fact, the risk of driving to work every day may outweigh those of some procedures offered.  The risk of permanent visual damage following blepharoplasty is less than 1%.  The best way to avoid this is close observation and follow up.  If pain evolves following surgery or there is even a hint of visual obstruction, immediate attention can avoid long term problems.  It is sometimes the result of bleeding, which, if immediately controlled, is inconsequential.

The risk is very small and your surgeon can take steps to further control and reduce the risk of bleeding behind the eye which is by far the most common basis for this problem.  One thing you can do is avoid medications, over the counter products and herbal preparations that are likely to increase the risk of bleeding.  Products like Aspirin, Advil, and all nonsteroidal antiiflammatory agents, and herbal products like Ginko increase this risk.  Many people are on drugs that reduce the risk of making clots like Plavix.  There are medical risks of discontinuing these products without the strict guidance of your physician.  It is important that you disclose to your potential surgeon what you are taking.  When there is a medical reason for anticoagulation, it is generally advisable to postpone cosmetic eyelid surgery.  The risk of bleeding behind the eyelid with an increased risk of visual loss is one reason.  Another reason is that eyelid hemorrhage also can compromise the surgical outcome.

It is true that both blindness and double vision are potential complications of eyelid surgery.  However, these are exceedingly rare complications in experienced, conscientious hands.  Informed consent is the Surgeon's duty and it is the patient's responsibility to weigh the risks and benefits of any procedure.  See an experienced Facial Plastic Surgeon, Occuloplastic Surgeon, or Plastic surgeon when considering eyelid surgery.

The chance of permanent blindness or double vision is extremely rare in upper or lower blepharoplasty surgery. Uncontrolled bleeding immediately would cause these types of issues. The eyes are protected during the time of the surgery with corneal eye protectors. We avoid using the laser around the eyes because of any risk of the laser damaging the eyesight. Careful and meticulous surgery is very important and when performed in a controlled surgical environment the risk is very, very minimal.  

Caution with an attention to safety is a top priority with any surgical procedure.  With eyelid surgery the eye itself must be protected as well as any bleeding controlled.  These two problems could lead to vision problems following eyelid surgery.  You will be instructed to be off medications that could lead to abnormal bleeding prior to surgery.  There is a risk with any procedure but with skill and attention to detail this will be kept to an absolute minimum.  

Eyelid surgery, also known as Blepharoplasty, is usually a very safe and effective procedure.  However, there is a very remote risk of serious complications, including double vision, or loss of vision.  Loss of vision is extremely rare, and is due to internal bleeding causing nerve damage.  In order to minimize any chance of this complication, I insist that  my patients avoid any medications that affect blood clotting (ie: no aspirin, ibuprofen, naprosyn), and avoid any vitamins or supplements for 2 weeks before and 2 weeks after the surgery.  Blood pressure must also be controlled, and I caution against any strenuous activity for at least 3 weeks after surgery.  I also check bloodwork to assure adequate platelet counts prior to surgery. 

Yes, this is always possible, but is extremely rare.  This is part of the list of things that as a doctor we have to talk about during consultation as part of the risks of surgery, but I will emphasize it is very rare.

Yes a very rare risk, but still a risk. Discuss in detail with the chosen boarded surgeon. I have never seen blindness with blepharoplasty but I have heard of it in my 30 years of private practice. 

Dear John,   Unfortunately, what we all have to tell our patients is that nothing is without some risk!  On my consents, I even have "death" noted as a risk because I can't tell anyone that there is zero chance of that.  But the chance of death, double vision, or blindness in these types of cases in a healthy individual is very very low.

The chance of double vision occurs if there is damage to the eye muscles during surgery.  Make sure that the surgeon you are working with is either an oculoplastic surgeon or someone with a lot of experience operating in this area.  The chance of blindness comes generally from damage to the optic nerve (nearly impossible with eyelid procedures) or severe hemorrhage that may get trapped behind the eye and compress the optic nerve.  If possible, your doctors will have you discontinue any blood thinners to minimize that risk (Of course if you are on blood thinners because of a history of heart disease or stroke, discontinuing those medications may increase your chance of those types of problems too, which should be carefully considered with your team of doctors.)    Finally damage to the front of the eye can also cause loss of vision, but that is also rare.  I use metal shields over the cornea to limit this problem.

All in all, there is risk in everything you do, including driving your car into the doctor's office for your exam.  So as an individual, make sure you think the benefit that you think you will obtain from surgery outweighs the small risk you take.

Good luck!

Jasmine Mohadjer, MD

Vision loss and double vision are known complications of eyelid surgery. Fortunately, these complications are rare. Your  surgeon will explain these risks in detail at the time of your consultation.

All surgeries do have potential complications and it is important that you consider them carefully when you are making your choices

Hope this helps.