Facial movement induced diplopia after transconjuctival lower bleph with fat repositioning. Cause? Permanent? Solution?

Question

I had surgery 4 months ago. Ocularplastic Surgeon has never come across this issue before and has since retired. Diplopia in right eye after surgery whilst looking down and outwardly lasting 7 weeks due to inflammation from vessel cauterisation. Mostly resolved as long as face is static. if I chew, talk, rub lips together or stretch face obliquely, the vision in my right eye distorts causing double vision whilst looking down to mid level . If I hold mid cheek up, it resolves. Please advise. Thx

Brooke R. Seckel, MD, FACS (retired) · Answer

I am very sorry to hear of of your difficulty after trans-conjunctival lower blepharoplasty.  During trans-conjunctival lower blepharoplasty the inferior oblique muscle is exposed to injury.  However typically injury to the inferior oblique muscle results and double vision when the affected eye is turned inward and down not outward and down.  If you have double vision looking outward and down then the eye on the opposite side of the direction of gaze is likely the one involved.  I would see a neuro-ophthalmologist for an examination and diagnosis.  It is hopeful that you are improving.  However if the double vision is permanent then exploration and possible muscle repair may be indicated.

Facial movement induced diplopia after transconjuctival lower bleph with fat repositioning. Cause? Permanent? Solution?

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