Upper Blepharoplasty May Raise Intraocular Pressure

Upper blepharoplasty procedures may be associated with increased intraocular pressure (IOP), according to a study published in Ophthalmic Plastic and Reconstructive Surgery.¹

Researchers from Brazil conducted a prospective study into the effect of upper blepharoplasty on IOP to determine if the procedure could impact patients with, or suspected of having, glaucoma.¹

Patients with mild-to-moderate dermatochalasis were recruited for the study. All patients, including those in the control group, received a complete ophthalmic examination, including IOP measurements. Only those with normal ophthalmic exams were enrolled in the study. Patients being treated for glaucoma or suspected of having the disease were excluded. 

The team evaluated IOP in 20 patients (40 eyes) before surgery and again at 1, 2, and 6 weeks post-surgery. Corneal topography also was imaged pre-op and 6 weeks after surgery. A statically significant increase in IOP was noted at 1 (15.15±2.27 mm Hg, P =.009), 2 (15.57±2.29 mm Hg, P <0.0001), and 6 weeks (15.21±2.60 mm Hg, P =0.001) post-surgery. A statistically significant increase in steep K (preoperative: 44.66±2.06, 6 weeks: 44.78±2.28, P =0.007) and corneal astigmatism also was noted (preoperative: 0.78±0.43, 6 weeks: 0.89±0.45, P =0.006) at 6 weeks.¹

Researchers speculated as to the cause of the association by likening the outcome of the procedure to tight orbit syndrome, a condition characterized by eyelids pressing firmly against the globe, which is also associated with high IOPs.¹ Patients who undergo upper blepharoplasty experience mass changes around the globe and upper eyelid skin, the authors explain.¹ This results in higher tissue tension on the globe and any external pressure on the globe, even something as minor as the patient squeezing their lids, can increase pressures.¹

A previous study found that an IOP increase of only 1 mm Hg was associated with an approximate 10% increased risk of glaucoma progression.² Even a small elevation in IOP can result in optic neuropathy.¹ For this reason, the authors suggest all blepharoplasty candidates are evaluated for glaucoma or even suspicion of glaucoma.¹

References

1. Osaki TH, Osaki MH, Ohkawara LE, Osaki T, Gameiro GR, Melo LAS Jr. Possible influence of upper blepharoplasty on intraocular pressure. Ophthalmic Plast Reconstr Surg. 2020;36(4):346-348.  doi:10.1097/IOP.0000000000001541.
2. Leske M, Heijl A, Hussein M, et al. Early manifest glaucoma trial group. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol. 2003;121:48-56.