Visual Loss after Cosmetic Blepharoplasty Using Local Anaesthesia Containing Epinephrine - A Case Series

RATIONALE: Surgeons should be aware of the risk of vision loss associated with blepharoplasty. PATIENT CONCERNS: All patients complained of decreased vision, redness and/or pain after blepharoplasty using only local anaesthesia containing epinephrine. DIAGNOSIS: Diagnosis of angle-closure glaucoma (ACG) was made clinically (decreased visual acuity (VA), increased intraocular pressure and a mid-dilated pupil) and through examination (slit lamp examination and dynamic gonioscopy revealed corneal oedema and a shallow anterior chamber respectively). Perioperative posterior ischaemic optic neuropathy (PION) was a diagnosis of exclusion based on the relative afferent pupil defect. TREATMENT: ACG was treated medically (intravenous [IV] mannitol and topic antiglaucoma medication or oral acetazolamide) and surgically (YAG iridotomy and an additional cataract extraction with trabeculectomy in one patient). PION was treated with IV methylprednisolone. OUTCOME: Patients with ACG fully recovered. Patients with PION improved clinically, but presented with a pale optic disc and an optic nerve-related visual field defect. TAKE-AWAY LESSON: Surgeons should intervene quickly to minimize the chance of permanent vision loss.