Acute Onset Endophthalmitis Following Bilateral Upper and Lower Eyelid Blepharoplasty

Abstract

A 59-year-old woman presented with iritis and uveitis in the OD approximately 3 weeks after she underwent a bilateral upper and lower blepharoplasty by an outside oculoplastic specialist. Examination revealed a visual acuity of hand motion in the OD, scleral ulceration suspicious for prior globe perforation, dense vitritis, and loculations and membranes on echography. The patient was diagnosed with acute onset exogenous endophthalmitis. Vitreous aspiration and intravitreal injection of vancomycin and ceftazidime were performed. The patient underwent a pars plana vitrectomy, and vitreous culture demonstrated Streptococcus pseudoporcinus. Postoperative vision improved to 4/200 but was limited by a full-thickness macular hole. Despite silicone oil removal and macular hole repair, the macular hole remained open at month 7 and limited vision to 5/200. During eyelid surgery, surgeons should take precautions against intraoperative needle perforation including possible use of protective shield. Postoperative vision loss after eyelid surgery requires further evaluation.

Beyond the Surface: A Systematic Review of Perforating and Penetrating Globe Injuries From Blepharoplasty

“…Three patients developed endophthalmitis, all associated with full-thickness scleral perforations. 3,10,12 Of the 12 patients requiring closure of the wound, 9 (75%) received surgical intervention and 3 (25%) received topical tissue adhesive.…”

“…After careful review of all resultant published articles (483), we identified 13 previously reported cases of corneal and scleral penetrating and perforating injuries after blepharoplasty (Table 2). 3,[6][7][8][9][10][12][13][14][15][16] In order to provide a more robust understanding of globe injuries from blepharoplasties, the 3 new cases reported above were integrated with the 13 previously reported in the literature.…”