Anderson R L, Edwards J J
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City 52242.
Ann Plast Surg. 1980 Oct;5(4):288-92. doi: 10.1097/00000637-198010000-00007.
Blindness following blepharoplasty is a well-documented complication. Removal of orbital fat is common to most cases in which such blindness occurs. We present a patient who was referred to us following blepharoplasty involving orbital fat removal in all four lids with subsequent onset of bilateral visual loss. Visual acuity in the right eye has remained no light perception and in the left eye improved from 20/400 to 20/20 following bilateral orbital decompression. An electroretinogram was within normal limits in both eyes. A normal response from the visual evoked response in the left eye and an abnormal response from the visual evoked response in the right eye indicate ganglion cell damage or visual pathway disruption in the right eye, probably secondary to optic nerve ischemia. We conclude that the small nutrient vessels to the optic nerve are more easily compromised than the central retinal artery and are responsible for the visual loss in many of these cases. We believe this to be the first documented case of bilateral visual loss following blepharoplasty and the first electrophysiological study demonstrating the pathophysiology of blindness following blepharoplasty. We advocate rapid orbital decompression to treat this catastrophic complication.
睑成形术后失明是一种有充分文献记载的并发症。眼眶脂肪去除是大多数此类失明病例的常见操作。我们报告一位患者，其在双眼睑进行了眼眶脂肪去除的睑成形术后被转诊至我们这里，随后出现双侧视力丧失。右眼视力一直无光感，左眼在双侧眼眶减压后从20/400提高到了20/20。双眼的视网膜电图均在正常范围内。左眼视觉诱发电位正常反应，右眼视觉诱发电位异常反应表明右眼神经节细胞受损或视觉通路中断，可能继发于视神经缺血。我们得出结论，视神经的小营养血管比视网膜中央动脉更容易受到损害，并且是许多此类病例中视力丧失的原因。我们认为这是首例有文献记载的睑成形术后双侧视力丧失病例，也是首例通过电生理研究证明睑成形术后失明病理生理机制的病例。我们主张迅速进行眼眶减压以治疗这种灾难性并发症。
