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

Surgeons should be aware of the risk of vision loss associated with blepharoplasty.

All patients complained of decreased vision, redness and/or pain after blepharoplasty using only local anaesthesia containing epinephrine.

Diagnosis of angle-closure glaucoma (ACG) was made clinically (decreased visual acuity (VA), increased intraocular pressure and a mid-dilated pupil) and through examination (slit lamp examination and dynamic gonioscopy revealed corneal oedema and a shallow anterior chamber respectively). Perioperative posterior ischaemic optic neuropathy (PION) was a diagnosis of exclusion based on the relative afferent pupil defect.

ACG was treated medically (intravenous [IV] mannitol and topic antiglaucoma medication or oral acetazolamide) and surgically (YAG iridotomy and an additional cataract extraction with trabeculectomy in one patient). PION was treated with IV methylprednisolone.

Patients with ACG fully recovered. Patients with PION improved clinically, but presented with a pale optic disc and an optic nerve-related visual field defect.

Surgeons should intervene quickly to minimize the chance of permanent vision loss.