Kosin Med J.  2018 Dec;33(2):208-214. 10.7180/kmj.2018.33.2.208.

Transient Inferior Oblique Muscle Palsy Following Transconjunctival Lower Lid Blepharoplasty

• Lee HJ
• Rhiu S
• Oh DE
• Jeong JH

• KMID: 2430736
• DOI: http://doi.org/10.7180/kmj.2018.33.2.208

Abstract

Although the inferior oblique (IO) muscle is positioned considerably deep in the orbit, transconjunctival lower lid blepharoplasty may affect it and transient or permanent IO muscle palsy might result. Therefore diplopia should be explained before cosmetic blepharoplasty performed with transconjunctival approach.

Keyword

Blepharoplasty; Diplopia; Hypertopia; Inferior oblique muscle

MeSH Terms

Blepharoplasty*
Diplopia
Jupiter
Orbit
Paralysis*

Figure

• 

  Fig. 1 Nine gaze extraocular movement photography show left hypotropia in right upper and upgaze at the initial presentation (white arrows).

• 

  Fig. 2 Lancaster test demonstrates esotropia and intorsion in both eyes, and left hypotropia at the initial presentation.

• 

  Fig. 3 Fundus photography show suspicious intorsion in both eyes at the initial visit.

• 

  Fig. 4 Extraocular movement photography demonstrate limitation of elevation at right upper gaze in the left eye 1 month following blepharoplasty (white arrow).

• 

  Fig. 5 Extraocular movment photography show decreased limitation of elevation at right upper gaze in the left eye 2 month following blepharoplasty (white arrow).

Reference

1. Ghabrial R, Lisman RD, Kane MA, Milite J, Richards R. Diplopia following transconjunctival blepharoplasty. Plast Reconstr Surg. 1998; 102:1219–1225.

2. Frankel J. Avoiding injury to the inferior oblique muscle during lower lid blepharoplasty. Plast Reconstr Surg. 2003; 112:1958–1959.

3. Syniuta LA, Goldberg RA, Thacker NM, Rosenbaum AL. Acquired strabismus following cosmetic blepharoplasty. Plast Reconstr Surg. 2003; 111:2053–2059.

4. Mazow ML, Avilla CW, Morales HJ. Restrictive horizontal strabismus following blepharoplasty. Am J Ophthalmol. 2006; 141:773–774.

5. Baylis HI, Long JA, Groth MJ. Transconjunctival lower eyelid blepharoplasty. Technique and complications. Ophthalmology. 1989; 96:1027–1032.

6. Nerad JA. Oculoplastic surgery: the requisites in ophthalmology. 1st ed. St.Louis: Mosby;2001. p. 39–45.

7. Klapper SR, Patrinely JR. Management of cosmetic eyelid surgery complications. Semin Plast Surg. 2007; 21:80–93.

8. Pirouzian A, Goldberg RA, Demer JL. Inferior rectus pulley hindrance: a mechanism of restrictive hypertropia following lower lid surgery. J AAPOS. 2004; 8:338–344.