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Commentary |

To Patch or Not to Patch? That Is the Question

Richard L. Anderson, MD; Dan Georgescu, MD, PhD; M. Reza Vagefi, MD; Tristan F. W. McMullan, PhD, MRCOphth; John R. Burroughs, MD; John D. McCann, MD, PhD
Arch Facial Plast Surg. 2007;9(4):290-292. doi:10.1001/archfaci.9.4.290.
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There is good evidence that surgery around the eyes can result in orbital hemorrhage, the most severe complication of which is vision loss. Bleeding can occur with primary orbital operations as well as with eyelid procedures that extend beyond the septum, the most common being blepharoplasty. More than 168 cases of orbital hemorrhage after blepharoplasty have been reported, 19 of which were associated with permanent vision loss.1-8 It has been estimated that the incidence of orbital hemorrhage after blepharoplasty is approximately 1:2000 and that of permanent vision loss is 1:22 000 (0.0045%).1

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Figure 1.

Immediate (A) and 1-day (B) postoperative photographs of a 67-year-old man who underwent bilateral upper and lower eyelid blepharoplasty with fat removal and external levator resection. The right eye was patched tightly because of intraoperative bleeding resulting in a retrobulbar hemorrhage with swelling and proptosis noted immediately after surgery. An improved cosmetic appearance of the right eye, with reduction of proptosis and edema that is comparable to the unpatched left eye, is demonstrated on postoperative day 1. Visual function was preserved.

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Figure 2.

Immediate (A) and 2-day (B) postoperative photographs of a 43-year-old man who underwent bilateral myectomy surgery for blepharospasm and apraxia of the eyelid opening. A, Bilateral, tight patching can be tolerated, as demonstrated in this photograph. B, The patient's eyes on postoperative day 2 are much less ecchymotic and edematous than they would have been had they not been patched.

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