Visual Disturbances After Deep Plane Facelift with Blepharoplasty
Most visual disturbances following blepharoplasty are transient and improve within 8 to 15 months if they result from local injury or hemorrhage without permanent loss of function or significant scarring. 1
Expected Timeline for Resolution
Strabismus (eye misalignment causing diplopia) may be transient after blepharoplasty or other eyelid surgery, with many cases improving after 8 to 15 months. 1 This timeframe applies specifically to cases resulting from local injury or hemorrhage without permanent functional loss or significant scarring. 1
Types and Duration of Visual Complaints
Subjective Visual Changes (Blurred Vision)
- Approximately 5.7% of patients report subjective visual acuity changes 1 year after upper blepharoplasty. 2
- The incidence increases to 6.7% (4 of 6 patients) when blepharoplasty is combined with ptosis repair. 2
- These changes are often due to astigmatic alterations from eyelid repositioning and may require new prescription spectacles or contact lenses postoperatively. 2
Dry Eye Symptoms
- Dry eye symptoms occur in 26.5% of patients following blepharoplasty. 3
- Symptoms typically improve with time, though in certain cases they may persist for months or years. 1
- Risk factors include concurrent upper and lower blepharoplasty, skin-muscle flap technique, hormone therapy use, and preoperative scleral show. 3
Diplopia (Double Vision)
- New-onset diplopia can occur after upper lid blepharoplasty, sometimes associated with trochlear damage. 1, 4
- Diplopia persisting after several months warrants referral to a strabismus specialist. 1
- Scarring, hemorrhage in adjacent tissue, or fat adherence have been implicated as mechanisms. 1, 4
Management Algorithm
Early Period (First 8-15 Months)
- Monitor with prisms for transient strabismus during the early postoperative period. 1
- Prisms may be offered early for symptomatic relief while awaiting spontaneous resolution. 1
- Supplemental lubrication, topical cyclosporine eyedrops, and punctal occlusion may help manage dry eye symptoms. 1
After 8-15 Months
- For persistent strabismus beyond 8-15 months, surgical correction should be considered. 1
- Patients may require multiple surgeries, including surgery on the non-affected eye. 1
- Surgery is particularly indicated when there are limited ocular rotations in the affected eye. 1
Critical Caveats
Diplopia that is often incomitant (varies with gaze direction) makes prism correction rarely satisfactory in the long run, particularly when diplopia occurs in primary or reading position. 1 This is an important consideration when counseling patients about temporary versus definitive management options.
The risk of permanent visual complications is extremely low but serious: permanent visual loss occurs in approximately 0.0033% (one in 30,000) of blepharoplasty cases. 5 However, the more common visual disturbances discussed above are typically self-limited.
Patients should be counseled preoperatively that upper eyelid repositioning procedures may induce long-term vision changes requiring new corrective lenses. 2 This is particularly important for combined procedures involving both blepharoplasty and ptosis repair. 2