Miscellaneous Complications
There are a wide variety of complications that can occur following blepharoplasty surgery. The most critical vision-threatening causes include orbital hemorrhage and orbital cellulitis. More frequent complications can include periorbital hematoma, allergi
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Elaine M. Downie and Cat Nguyen Burkat
Hemorrhage The most feared complication of periocular surgery is permanent loss of vision. When it occurs, it is most frequently due to orbital compartment syndrome related to retrobulbar hemorrhage. In one large study looking at more than 250,000 cases, the incidence of orbital hemorrhage was found to be 0.05%, with permanent visual occurring in 0.0045% or 1/22,000 cases [1]. Manipulation of orbital fat or incisions extending into the orbital septum increase the risk of hemorrhage that may lead to possible blindness. Hemorrhage may be due to traction on or resection of orbital fat, leading to unidentified intraoperative hemorrhage, or may be due to delayed bleeding in patients who are anticoagulated or who have systemic hypertension [2]. Orbital hemorrhage usually occurs within the first 24 hours after surgery, especially in the first few hours postoperatively, but can be seen even several days following surgery. Use of patches or bandages postoperatively should be discouraged to allow bleeding to be discovered quickly. Acute orbital hemorrhage is a medical emergency. Signs of hemorrhage include decreased visual acuity, tense periorbital hematoma, brisk incisional bleeding, proptosis, severe pain, and presence of a relative afferent pupillary defect. If there is significant increase in intraocular pressure, topical intraocular-pressure-lowering medications, such as carbonic anhydrase inhibitors and β-blockers, can be used. In the event of a retrobulbar hemorrhage, especially if there is evidence of vision loss or afferent pupillary defect, immediate release of the compartment should be attempted. Decompression can be performed in the emergency, clinic, or operating E. M. Downie ∙ C. N. Burkat (*) Department of Ophthalmology & Visual Sciences, University of Wisconsin – Madison, Madison, WI, USA e-mail: [email protected]
© Springer Nature Switzerland AG 2020 M. E. Hartstein et al. (eds.), Avoiding and Managing Complications in Cosmetic Oculofacial Surgery, https://doi.org/10.1007/978-3-030-51152-4_24
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room; but urgency is of paramount importance. The first step is to open the surgical wounds. If this does not allow sufficient decompression of the hematoma, then a lateral canthotomy with lysis of the inferior and/or superior crus of the lateral canthal tendon should be performed [2, 3] (Fig. 24.1). In the event that adequate decompression of the orbital hemorrhage is still not achieved, the patient should be urgently returned to the operating room for surgical exploration. Rapid restoration of blood flow to the optic nerve and retina is critical to reduce permanent vision loss. In addition to vision-threatening orbital hemorrhages, patients can develop significant periorbital hematomas. They are usually related to bleeding from the orbicularis oculi muscle or may be from vessels injured during debulking of orbital fat pads [4]. These need to be distinguished from retrobulbar hematomas, and assessed for continued expansion versus a
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