Bilateral acute angle-closure glaucoma may occur after uneventful blepharoplasty

The Science behind the Tip

Bilateral acute angle-closure glaucoma is a possible (potentially blinding) complication after uneventful eyelid surgery. Predisposing factors include all underlying causes of a narrow anterior chamber such as hypermetropia and cataract. The various factors causing pupillary dilatation and angle closure are:

? local anesthesia containing adrenaline or anticholinergic drugs used during general anesthesia

? psychological stress

? dark-adapted eye under post-op bandage

In the literature only four case reports were found describing this complication(1-4), yet presumably it is often misdiagnosed and thus underreported. Moreover, blepharoplasty is frequently performed by plastic surgeons and dermatologists who are often unaware of this potentially blinding complication. Much valuable time may be lost before the correct diagnosis is made, especially since there can be considerable post-operative swelling of the eyelids making examination of the eye more difficult. Considering that immediate appropriate therapy may reverse the angle closure and thus prevent visual loss, a better awareness and prompt recognition of this condition is imperative.

Contributor: Kathy Hondeghem, Antwerp
Co-editors: John Thygesen and Ann Hoste
Peer reviewers: Roger Hitchings and Anders Heijl

References

1. Green MF, Kadri SW. Acute closed-angle glaucoma, a complication of blepharoplasty: report of a case. Br J Plast Surg. 1974;27:25-7.

2. Scuderi N, Recupero SM, D?Andrea F, et al. Glaucoma as etiopathogenic hypothesis of amaurosis after blepharoplasty. Apropos of a clinical case. Ann Chir Plast Esthet. 1990;35:410-3.

3. Gayton JL, Ledford JK. Angle closure glaucoma following a combined blepharoplasty and ectropion repair. Ophthal Plast Reconstr Surg. 1992;8:176-7.

4. Wride NK, Sanders R. Blindness from acute angle-closure glaucoma after blepharoplasty. Ophthal Plast Reconstr Surg. 2004;20:476-8.

Tip Reviewer: Roger Hitchings
Tip Editors: Ann Hoste, John Salmon and John Thygesen