Ophthalmologic Complications Associated With Oculofacial Plastic and Esthetic Surgeries:

Beyond the Surface: A Systematic Review of Perforating and Penetrating Globe Injuries From Blepharoplasty

PURPOSE

This study aims to address the infrequent but serious complication of globe injuries in blepharoplasty.

METHODS

A case series of 3 patients with globe injuries postblepharoplasty is presented, along with a systematic literature review that revealed 13 previously reported cases. Quantitative and comparative analysis is described.

RESULTS

Injuries ranged from deep thermal burns to full-thickness corneal or scleral lacerations, with one instance of traumatic cataract. The median time from surgery to symptom onset was 1 day, with a concerning median delay of 7 days to presentation to an ophthalmologist. Visual outcomes were generally poor, with nearly all patients experiencing permanent visual morbidity. The systematic review revealed 3 cases of endophthalmitis following perforating scleral injuries. Comparative analysis showed no significant differences in visual outcomes between penetrating and perforating injuries.

CONCLUSIONS

The findings of this study emphasize the need for increased vigilance for globe injuries that require prompt ophthalmological evaluation following blepharoplasty, especially considering the observed delay in presentation and the extent of visual morbidity. The study advocates for improved practitioner training in recognizing and managing these complications and underscores the importance of patient education regarding the potential risks and the necessity of timely postoperative care.

Thickness of the Medial Pretarsal Adipose Tissue in the Upper Eyelid among the Japanese Population

PURPOSE

To investigate the medial pretarsal adipose tissue thickness of the upper eyelid in the Japanese population.

METHODS

Sixty-two whole upper eyelids were harvested from 35 Japanese cadavers and fixed in paraffin. The samples were cut into 5 µm sagittal microsections and stained with hematoxylin and eosin, as well as Masson's trichrome. Data obtained from images and measurements were taken with Aperio ScanScope and ImageScope software and underwent statistical analysis.

RESULTS

The samples were divided into 3 shapes sagittal cross-sections of the eyelid (triangular, rectangular, and flat) corresponding to the shape of the medial pretarsal adipose tissue. Type I (triangular shape, 48.4%) had a ratio of fat thickness at 1⁄2 tarsal height to peak fat thickness of <0.9, and type IIa (rectangular shape, 30.6%) and IIb (flat shape, 21.0%) had pretarsal adipose tissue thickness to tarsal height ratio of ≥0.2 and <0.2, respectively. The mean values of tarsal thickness at 1⁄2 tarsal height were 1021 µm for the type I group, 1100 µm for the type IIa group, and 764.4 µm for the type IIb group ( p = 0.01). The mean values of fat thickness at 1⁄2 tarsal height were 410.6 µm for the type I group, 303.3 µm for the type IIa group, and 242.6 µm for the type IIb group ( p = 0.26).

CONCLUSIONS

The thickness of the medial pretarsal adipose tissue was different according to the shape of the sagittal cross-section of the eyelid. Awareness of the medial pretarsal adipose tissue thickness contributes to effective suture placement and safe suture depth during blepharoptosis surgery.

Severe Corneal Damage After Minor Eyelid Surgery: A Case Series

OBJECTIVES

To present three cases of serious corneal complications after seemingly minor and uncomplicated eyelid surgery.

METHODS

These cases emphasize the real-world risk of corneal damage after oculoplastic surgery.

RESULTS

The first case is a 46-year-old man referred to our department with a corneal perforation after bilateral blepharoplasty of both upper and lower eyelids. The second case concerns a 51-year-old woman who suffered an accidental coagulation of the cornea during the removal of upper eyelid papillomas, and the third case is a 55-year-old woman who had severe corneal thinning accompanied by visual loss after an upper lid blepharoplasty. All patients were stabilized without the need for corneal transplantation, although there were significant corneal scars and sequelae.

CONCLUSIONS

Although complications after esthetic oculoplastic surgery are rare, the reported cases show that corneal damage can have a major impact on the patient's vision and quality of life. Strategies such as the use of a corneal shield can be used to mitigate these risks, but their use is debated. Nevertheless, diligent postoperative care is paramount. At the first postoperative visit, a basic visual acuity measurement should be performed. In cases where reduced vision is reported, particularly when accompanied by pain, patients should be urgently referred for specialized eye care.

Modified lateral canthopexy with upper and lower blepharoplasties for aesthetic refinements: My personal technique

BACKGROUND

Blepharoplasty is a surgical procedure that modifies the shape and structure of the eyelids to restore a more youthful appearance. The procedure comprises the removal of extra muscle, fat, and skin. In order to get the optimum functional and aesthetic result, supporting components like canthal tendons can also be tightened.

AIM

To evaluate the efficacy of canthopexy in conjunction with the upper and lower blepharoplasty technique and its complications.

METHODS

A total of 400 individuals who underwent these procedures between January 2020 and January 2021 had been recruited for this study. The frequency and clinical complications were analyzed.

RESULTS

The complications were found to be 17 (4 %) cases of relapse, 12 (3 %) temporary hematoma formation, 11 (3 %) cases of epiphora, 8 (2 %) cases of unequal eyelid positioning, 5 (1 %) patients developed conjunctivitis and chemosis.

CONCLUSION

This method appears to be effective since it is simple, practicable, and capable of delivering positive functional and aesthetic effects with a minimum of side effects.

Case report: Utilization of a scleral lens to mitigate exposure keratopathy and associated mental health decline

PURPOSE

To report a case of acute exposure keratopathy with comorbid depression and improvement of both conditions with the use of a scleral lens (SL).

OBSERVATIONS

A 72-year-old male with a past ocular history significant for extensive basal cell carcinoma (BCC) excision of the right upper and lower eyelids presented for evaluation of exposure keratitis and consideration of a SL for the right eye. Examination was notable for post-surgical irregular lid margins with lagophthalmos, trichiasis and an Oxford Grade I staining of the central exposed cornea. Medical history was notable for chronic severe depression and anxiety with suicidal ideation. Upon treatment with a SL, the patient noted ocular comfort, and reported significantly improved affect.

CONCLUSION AND IMPORTANCE

Currently, there is no peer reviewed literature reporting on the management of exposure keratopathy in the setting of comorbid affective disorders. This case highlights the improvement in quality of life for a patient with exposure keratitis and severe depression with suicidal ideation and points to the potential utilization of a SL to mitigate the risk of mental health decompensation.

Reducing Surgical Risks in a Blepharoplasty

Blepharoplasty is one of the commonest procedures performed for facial rejuvenation. The eyelids play a vital role in maintaining ocular surface integrity and visual functioning. Care must be taken to avoid complications that pose a risk to vision and ocular comfort. In addition, cosmetic complications can adversely affect patient satisfaction. Here the authors review the common complications encountered with blepharoplasty surgery and discuss how to minimize the risk of these and how to treat them if they do arise. With careful preoperative patient counseling, sound intraoperative technique, and appropriate postsurgical care, blepharoplasty remains a safe and well-tolerated procedure.

What is in a Name? It is Time to Retire the Term "Asian Blepharoplasty"

PURPOSE

This perspective explores the term "Asian blepharoplasty" and its socioemotional meaning to some patients.

METHODS

N/A.

RESULTS

Words have power. The term "Asian blepharoplasty" makes some patients uncomfortable. To our knowledge, it is the only medical descriptor that uses race.

CONCLUSIONS

The use of the term "Asian Blepharoplasty" may unwittingly make patients uncomfortable and pathologize Asian features. Therefore, we suggest replacing the term "Asian Blepharoplasty" with "Double Eyelid Surgery." For the subset of procedures which do not include the creation of an eyelid crease, "Blepharoplasty" is appropriate.

Novel "all-in-one" sandwich technique for reconstruction of full-thickness defects of the lower eyelid: a case report

The current paper presents a case report of lower eyelid reconstruction after removal of a basal cell carcinoma. Our novel reconstruction method consists of translation and rotation of a paramedian forehead flap into the defect, conjunctivorhinostomy for reconstruction of the nasolacrimal duct, and placement of a sandwich ear cartilage graft that is primarily seated into the forehead flap to maintain the vertical dimension of the eyelid. This “all-in-one” technique has the advantage of one-step reconstruction, avoiding multiple surgical procedures.

Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms

BACKGROUND

Upper eyelid ectropion occurs as a post-blepharoplasty complication or involution change, and it causes dry eye symptoms that cannot be resolved with conservative management.

OBJECTIVES

The aim of this study is to describe the authors' surgical technique of anatomical correction of upper eyelid ectropion, including tarsal scoring incision.

METHODS

The technique involves the following 4 steps: (1) adhesiolysis at the preaponeurotic layer; (2) undermining and redraping of the pretarsal flap in a pretarsal plane; (3) optional, partial thickness tarsal scoring incision over the central two-thirds; and (4) downward repositioning of the pretarsal flap and lower fixation to the tarsus. Outcomes were assessed based on the position of eyelid margin and the improvement of the dry eye symptoms.

RESULTS

A retrospective review of 54 cases of patients who underwent ectropion correction, including tarsal scoring incision, was performed. The eyelid margin was well positioned in 51 patients (94.4%). Of the 32 patients involved in the study assessed with the 7-point Patient Global Impression of Improvement, 29 (90.6%) reported the resolution of dry eye symptoms. Furthermore, in the 22 patients assessed with the Ocular Surface Disease Index, the mean score significantly decreased from 43.2 ± 24.1 before surgery to 29.8 ± 23.3 (P = 0.006) after surgery.

CONCLUSIONS

The combination of partial-thickness tarsal plate scoring and lower flap redraping surgical techniques resolved the upper eyelid ectropion, reducing the dry eye symptoms.

LEVEL OF EVIDENCE: 4

Lacrimal Ductal Fistula After Lateral Canthoplasty

We report a rare case of lacrimal ductal fistula in a patient who underwent esthetic lateral canthoplasty. A 37-year-old woman was referred to our hospital with tearing in right eye after cosmetic lateral canthoplasty of both eyes. The patient was treated with silicone tube intubation at a local medical center, but the symptoms were not resolved. Lacrimal sac irrigation tests and paranasal computed tomography (CT) were performed to analyze the possibility of lacrimal pathway obstruction. However, there was no evidence of acquired lacrimal duct stenosis. The teardrop leaked out through a small orifice in the right lateral canthal area and it increased in size over time. We identified lacrimal ductal fistula and performed lacrimal fistulectomy. The tearing at right lateral canthus area was resolved. There were no more recurrences nor any other complications 2 years after surgery.

Complications in Facial Esthetic Surgery

Esthetic surgery continues to become increasingly popular both in the United States and globally. Facial esthetic procedures in particular account for a large proportion of procedures performed. This increase in popularity will inevitably result in the number of potential complications associated with these procedures. In this review, the authors describe common complications encountered with frequently performed cosmetic facial procedures and their associated management. This article is meant as a general overview and introduction to potential complications surgeons may encounter, interested readers are encouraged to further review comprehensive subspecialty literature for more detailed discussion.