Retrobulbar hematoma and blepharoplasty.

Retrobulbar hematoma leading to visual impairment is a rare but serious complication associated with elective blepharoplasty. A review of the literature addressing etiology, prevention, and management is presented. Removal of anterior orbital fat associated with traction and rupture of vessels within posterior orbital fat is currently most strongly supported as the cause of retrobulbar hematoma after blepharoplasty. Optic nerve ischemia is identified as the likely cause of visual impairment. Specific recommendations for avoidance and management of acute retrobulbar hematoma are offered. Recent background animal and human research is summarized.