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Topic 28 - 7
Persistent Vision Change
After Blepharoplasty
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Temporary alteration of vision after blepharoplasty is extremely common in the first few weeks after surgery due to issues like swelling, tearing, dry eyes, and eye ointments. But what about more persistent change in the months and years that follow? Is that possible?

Yes, and it's more common than you probably think. We're not talking here about catastrophic vision loss that can occur rarely due to deep orbital hemorrhage. Rather, it's more a matter of mild to, at most, moderate visual interference that starts postoperatively and lasts for over a year or longer. It appears most often in patients undergoing upper blepharoplasty along with ptosis, or droopy eyelid, repair but can occur with upper blepharoplasty alone.

eyeball eyelid relationship

The cause appears to be creation of new astigmatism, an irregular change in the curvature on the eye's front surface, the cornea, that then blurs the visual image coming through it. Glasses or contacts that worked well before surgery may no longer do the trick.

In one study, such persistent visual alteration after blepharoplasty lasting longer than one year occurred in nearly 6%, or about 1 in 17, of patients queried.

Interestingly, some patients experienced improved vision with the new astigmatism, which, apparently, was in the opposite direction of preexisting astigmatism and so counteracted it.

There are plenty of other reasons for vision to become mildly blurry in the first month after surgery, including eyelid swelling, diminished blinking, incomplete closure, drooping of the lower eyelid away from eye, conjunctival swelling (chemosis), and so on. However, most of these disturbances are fleeting and resolve after a few months at most.

The cause for persistent blurring appears to be mechanical: in removing excess skin from a heavy upper lid, it's weight is lessened and its effect on corneal curvature is altered. The chance for astigmatic change is even more increased if upper blepharoplasty is accompanied by ptosis repair in which the entire full-thickness upper eyelid is lifted , thus taking even more "weight" off the cornea.

For patients with high demands for accurate vision (think computers, fine print, etc.), this subtle vision change may prove slightly to very annoying.

How long can it last? While unknown, it's not unreasonable to postulate that in at least some patients the effect may be very long-lasting or possibly permanent. Once the eyelids have fully healed, the only effective remedy for a persistent blur seems to be a change in glasses or contact lens prescription, or, if extreme, refractive eye surgery.

For reasons unknown, such unavoidable vision change, while not uncommon, is seldom discussed with patients beforehand. While not truly a "surgical complication," it still can create unexpected dismay and worry for the patient and stress on the doctor-patient relationship.

Next: Revision Blepharoplasty:

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