title: Perioperative posterior ischemic optic neuropathy as a rare complication of blepharoplasty.
abstract: OBJECTIVE
  To report a case of visual loss to light perception in the right eye after upper and lower eyelid blepharoplasty.
  
  
  METHODS
  Case report.
  
  
  METHODS
  A 46-year-old man was referred 3 days after combined bilateral upper and lower lid blepharoplasty with visual acuity of light perception in the right eye. The fundus examination, fluorescein angiography and magnetic resonance imaging of the orbit were normal. Ocular motility was full in all directions of gaze.
  
  
  RESULTS
  The diagnosis of optic nerve damage was initially based on the relative afferent pupillary defect. The diagnosis of a perioperative posterior ischemic optic neuropathy was based on the Goldmann visual field examination and the subsequent optic atrophy. Central visual acuity, color vision as well as the visual field improved markedly within 3 months.
  
  
  CONCLUSIONS
  Blindness is a rare but feared complication of blepharoplasty and is reported to occur in about 0.04% of cases. Although intraorbital hemorrhage is thought to be the leading cause for optic nerve damage in most of the patients with this devastating condition, we present a case with perioperative posterior ischemic optic neuropathy leading to visual loss after blepharoplasty. The mechanism leading to optic nerve damage in this patient may include compromised small arteries perfusing the optic disk due to direct mechanical compression and a probable vasoconstrictive activity of the anesthetic agent.
authors.affiliation: Department of Ophthalmology, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Kordic
authors.forename: J
authors.initials: J
authors.lastname: Flammer
authors.forename: A
authors.initials: A
authors.lastname: Mironow
authors.forename: H E
authors.initials: HE
authors.lastname: Killer
mesh_terms: D019882:Blepharoplasty / Q000009:adverse effects*; D001766:Blindness / Q000209:etiology; D005143:Eyelids / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis / Q000209:etiology*; D058609:Visual Field Tests; D014794:Visual Fields