Patients who underwent lower blepharoplasty had a greater three-year incidence of strabismus diagnosis (2.0% vs. 1.5%) and strabismus surgery (0.15% vs. 0.06%) vs. those who underwent upper blepharoplasty, IRIS Registry data shows. Photo: Kami Parsa, MD/Wikimedia Commons. Click image to enlarge.

Among the most common oculoplastic procedures today is blepharoplasty, involving the removal of excess tissue on the upper or lower eyelid, often (but not always) for cosmetic purposes. Diplopia due to extraocular muscle damage or local scarring is a known potential complication, though the relative risk of upper vs. lower eyelid procedures has not previously been studied. Researchers recently reported on this, along with the overall incidence of strabismus following blepharoplasty, in a large retrospective cohort study.

The team extracted data from adults 18 years and older in the IRIS Registry who underwent blepharoplasty between 2013 and 2020, totaling 368,623 patients. The study’s primary outcome was incidence of strabismus diagnosis and surgery within three years of blepharoplasty.

The results showed that individuals undergoing lower eyelid blepharoplasty have a higher risk of strabismus than those receiving surgery on the upper lid. Specifically, the researchers reported a greater three-year incidence of strabismus diagnosis (2.0% vs. 1.5%) and a greater three-year incidence of strabismus surgery (0.15% vs. 0.06%) in those undergoing lower vs. upper blepharoplasty.

A noteworthy limitation of this study is that patients in the IRIS Registry were followed only among participating practices; those who left and underwent strabismus surgery elsewhere were not accounted for. Additionally, outcomes were not stratified by surgical approach; for example, postoperative strabismus incidence rates may differ between transcutaneous and transconjunctival lower eyelid blepharoplasty, but this could not be determined from the data in this study.

The researchers summarized their findings in their paper, noting that “individuals undergoing lower blepharoplasty were at increased risk of developing and requiring intervention for strabismus.” Additionally, they wrote, “Analyses of large EHR registries enable inquiry into the incidence of infrequent complications of commonly performed procedures, and these data may help guide surgeons counseling their patients on the risks associated with blepharoplasty.”