Visual Loss after Cosmetic Blepharoplasty Using Local Anaesthesia Containing Epinephrine - A Case Series

Area of Science:

• Ophthalmology
• Plastic Surgery

Background:

• Blepharoplasty, a common cosmetic procedure, carries a risk of ocular complications.
• Local anesthesia with epinephrine in blepharoplasty has been associated with adverse visual outcomes.

Observation:

• Patients undergoing blepharoplasty with local anesthesia containing epinephrine reported decreased vision, redness, and pain.
• Clinical diagnosis included angle-closure glaucoma (ACG) and posterior ischemic optic neuropathy (PION).

Findings:

• Angle-closure glaucoma (ACG) was diagnosed based on decreased visual acuity, elevated intraocular pressure, and characteristic pupillary and anterior chamber findings.
• Posterior ischemic optic neuropathy (PION) was diagnosed as a diagnosis of exclusion, indicated by a relative afferent pupillary defect.
• Medical and surgical treatments for ACG led to full recovery.
• PION treatment resulted in clinical improvement, but persistent optic disc pallor and visual field defects were noted.

Implications:

• Surgeons must be aware of the potential for vision loss following blepharoplasty.
• Timely diagnosis and intervention are critical to mitigate permanent vision damage.
• Understanding the risks associated with local anesthetics containing epinephrine is essential for patient safety.