DIPLOPIA FOLLOWING TRANSCONJUNCTIVAL BLEPHAROPLASTY

The resurgence of popularity of the transconjunctival approach to lowe r eyelid fat removal as a component of cosmetic blepharoplasty has bee n highlighted by a number of publications in recent years. There has b een, ha however, minimal discussion in the literature of the complicat ions of this procedure. Although the mechanism of muscle injury is sim ilar in transcutaneous and transconjunctival surgery, there is a much more direct route to the inferior extraocular musculature via the latt er approach. Herein, we present a series of six patients with diplopia status post-transconjunctival lower eyelid blepharoplasty referred to the Manhattan Eye, Ear, and Throat Hospital for evaluation. Transconj unctival. lower lid blepharoplasty was performed as a primary procedur e in four patients and as a secondary procedure following transcutaneo us blepharoplasty in two patients. Patients were evaluated with ocular examination and orthoptic measurements. Magnetic resonance imaging wa s obtained in two cases. The inferior rectus and inferior oblique musc les were found to be equally injured in these cases (4 of 6), and the lateral rectus was encountered in one case. Two patients required stra bismus surgery to correct their diplopia, whereas four patients improv ed with observation alone. The possible etiologies of postoperative di plopia following transconjunctival lower lid blepharoplasty are manifo ld. Mechanisms of extraocular muscle injury may include intramuscular hemorrhage and edema, cicatricial changes within the muscle, and accid ental incorporation of extraocular muscle in closure of orbital septum . Avoidance of these complications is probably best achieved through i ntimate understanding on the part of the surgeon of eyelid anatomy fro m the transconjunctival perspective.