Crease Formation Linked With Postoperative Eyelid Edema

An investigation into postoperative eyelid edema shows that lid crease formation is significantly associated with Clinically significant eyelid edema (CSEE), according to researchers from the University of Southern California (USC), Los Angeles. The team highlighted the significance of early identification of risk factors that can lead to postoperative eyelid edema at the 2021 meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery. The study also found that the buried vicryl suture method was more significantly associated with CSEE than externalized silk sutures.

Eyelid edema is common following surgery of the upper eyelid. In most cases, swelling begins at the operative site and peaks in 2 to 3 days, usually subsiding within a few weeks. In some cases, however, eyelid edema persists for weeks or months postoperatively and poses risks to both the cosmetic and functional outcomes of the surgical procedure. Given this risk, it is essential to identify any risk factors that could be addressed to prevent and manage this complication. 

The primary objective of the researchers was to evaluate surgical factors potentially contributing to CSEE following eyelid surgery. 

Investigators performed a retrospective chart review on patients who underwent blepharoplasty with or without additional external levator advancement, lid crease formation, brow ptosis repairs, or lower eyelid surgery between January 2018 and January 2021; and for whom eyelid photos were taken postoperatively. The procedures were performed by 2 surgeons. Eyelid edema was graded by 2 independent graders, who viewed photographs of postoperative eyelid edema. The scale they used ranged from 0 (no edema) to 3 (severe edema). CSEE was categorized as a grade 3 at any point postoperatively or a grade 1 or higher after 90 days postoperatively. 

Of the 217 patients included in the study, 54 had a CSEE. Patients who underwent additional surgical procedures such as levator advancement, brow ptosis repairs, or lower eyelid surgery were not significantly likely to develop CSEE. Patients who required additional eyelid crease formation surgery were more likely to develop a CSEE (P <.0001). Among patients who underwent lid crease formation surgeries, 52.8% had CSEE vs 29% of patients who underwent levator advancement surgery without lid crease formation. Additionally, compared with externalized silk, the buried vicryl method was significantly associated with CSEE (P <.01). Among patients who underwent lid crease formation surgery, 71.9% were of Asian descent. Even when controlling for race, they noted a statistically significant relationship between lid crease formation surgery and CSEE; odds of prolonged/severe edema were 4 times higher in this group than in patients who did not undergo lid crease formation (95% CI, 1.7-9.6; P =.0018).

Researchers concluded that lid crease surgery and use of buried vicryl suture represent risk factors for development of postoperative lid edema. 

Reference 

Zhang-Nunes S, Guo S, Li J, et al. Surgical factors associated with clinically significant eyelid edema in patients following upper eyelid surgery. Poster presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium; November 11-12, 2021; New Orleans.