Open-globe injury associated with blepharoplasty

Abstract

Introduction
Open-globe injury including corneal or scleral perforation is an exceedingly rare but sight-threatening complication. We present a case of an open globe injury due to a full-thickness corneal laceration following upper eyelid blepharoplasty and provide a literature review of open globe injuries following blepharoplasty.
Report
A 44-year-old woman who underwent bilateral upper eyelid blepharoplasty presented with decreased vision and left eye pain one week postoperatively. On presentation, her visual acuity was 20/20 in the right eye and counting fingers in the left eye. Examination demonstrated a 7 mm full-thickness corneal laceration of her left eye, a shallow anterior chamber, and lens opacities. There was no evidence of retinal detachment, infection, or intraocular foreign bodies. She underwent immediate surgical repair of the corneal laceration. At her follow-up 6 weeks after the injury, she had residual astigmatism, corneal scarring, and lens opacities leading to decreased vision. Literature review through PubMed identified 8 previously reported open-globe injuries after blepharoplasty. The mean onset of symptoms was 2 days (range, 1-7 days) after the procedure, and the mean time between the procedure and diagnosis of open globe injury was 30 days (range, 2 days to 3 months). Five open-globe injuries were due to scleral perforation and four cases were due to corneal perforation. Most patients reported decreased vision (89%), ranging from 20/200 to hand motion, or pain (89%). Three (27%) patients had endophthalmitis accompanying open globe injury. Treatment varied depending on the location and extent of injury and presence of infection. Visual outcomes were poor; of six patients with outcomes, five had vision from 20/50 to 5/200, and only one patient had a postoperative visual acuity of 20/20 at a mean follow-up of 3.8 months.
Conclusion
Open-globe injuries secondary to blepharoplasties may result in severe and irreversible ocular damage.