Dr. Randolph Waldman wants his colleagues to know how important it is to be aware of rare complications that can unexpectedly arise, such as acute glaucoma post blepharoplasty.
Complications in aesthetic medicine are frequently discussed in terms of what is most common or likely and how to avoid or correct them. From the opposite end of the spectrum, facial plastic surgeon Randolph Waldman, M.D., wants to impart on his colleagues the importance of being aware of rare complications that can unexpectedly arise.
This was the topic of one of his presentations at this year’s Cosmetic Surgery Forum in Nashville, Tenn.
“Sometimes things seem very obvious, and perhaps that's not exactly what we're seeing. So, the first thing we need to do is to be good physicians, and have a good knowledge of medicine when we're doing any aesthetic treatment or surgery,” says Dr. Waldman, who heads a multi-specialty practice in Lexington, Ky.
“Sometimes we get problems and complications that are actually not really directly associated with what we do. We need to learn to recognize those,” he says.
One of those such cases is a blepharoplasty patient who in the first couple of days after surgery may report a loss of vision.
“They come in, you take a look at them and you don't really recognize any type of orbital hematoma or bleeding. You refer them to an ophthalmologist, and you're surprised to find out that, in fact, it represents a rare case of glaucoma - acute glaucoma - that requires surgical intervention,” says Dr. Waldman.
“…there is an incidence of glaucoma that's associated with blepharoplasty. But most of us aren't trained to recognize that,” he says.
In a study published in the Archives of Plastic Surgery, authors present a case study of a 64-year-old female patient who underwent a bilateral blepharoplasty with ptosis repair.1 Two days post-surgery, she experienced a stinging sensation with blurred vision in her right eye, along with a persistent headache on the right side of the head. Oral analgesics were prescribed for suspected conjunctivitis, but vision continued to deteriorate.
An ophthalmologist diagnosed acute angle closure glaucoma (ACG).
“Due to postoperative analgesic use, the clinical presentation can be mild and atypical, leading to a significant diagnostic delay,” the authors write.
They recommend ruling out acute ACG in patients who have similar complaints by performing pupillary reaction assessments.
“If a fixed mid-wide pupil is observed in an ophthalmologic examination, an immediate ophthalmology referral is warranted. Surgeons should be aware of this rare complication in order to offer treatment at an early stage and to minimize the chance of irreversible vision loss,” the authors explain.
In this instance, the authors report the patient regained eyesight one year after an ophthalmologist performed an iridectomy.
Importantly, Dr. Waldman points out that surgery in this case should be performed by a specialist, not by a plastic surgeon.
A good rule of thumb: When in doubt, refer to a specialist.
“That's why it's so very important to have ophthalmology colleagues that we can refer to even an on an emergency basis,” says Dr. Waldman. “And that blindness or loss of vision can take many different forms, have many different causes and can be associated with blepharoplasty.”
1. Kappen IFPM, Nguyen DT, Vos A, Van tits HWHJ. Primary angle-closure glaucoma, a rare but severe complication after blepharoplasty: Case report and review of the literature. Arch Plast Surg. 2018;45(4):384-387.