Apparent glaucomatous visual field defects caused by dermatochalasis

Abstract

SUMMARYWe have studied the effects of dermatochalasis on Humphrey automated perimetry of the central 24° visual field. Fifteen visual fields of 9 ocular hypertensive patients (18 eyes) were found to be incongruous with their apparently healthy optic discs. Examination revealed dermatochalasis, which was felt to be respon sible for the field defects. This was confirmed by reversal of the defects on repeating the field test (programme 24-2) with the redundant upper lid skin taped up, or in 2 cases following blepharoplasty. The defects always involved the superior visual field. The deepest and largest defects were sited in the supero temporal quadrant in 13 of the 15 affected fields and the supero-nasal quadrant in 2 fields. The most common pattern was a temporally skewed defect which reflected the tendency of the loose upper lid skin to be greater in extent temporally than nasally. In 7 fields the supero temporal defect extended to fuse with the blind spot, mimicking a superior arcuate scotoma. Temporal extension of the field defects below the horizontal meridian occurred in 5 fields. In cases where visual field testing was repeated without taping up the lid inter-test fluctuation in scotoma size and depth was observed, although the position of scotomas when present within the visual field remained constant. We conclude that dermatochalasis has the potential to confound diag nostic automated visual field testing for glaucoma.

Scheimpflug Imaging in Dermatochalasis Patients Before and After Upper Eyelid Blepharoplasty

“…1 Symptoms include cosmetic problems, difficulty in elevating the upper eyelids, and visual field restriction that may interfere with a patient's ability to perform daily activities. 2 The pressure of excess skin and prolapsed fat may cause alterations in corneal curvature. 3 Removal of excess skin and raising of the eyelid with blepharoplasty may lead to redistribution of the pressure applied by the lids over the cornea and consequently may result in corneal shape changes which can be documented through corneal topography.…”

Evaluation of Visual Field and Balance Function Alterations in Patients Who Underwent Dermatochalasis Surgery

“…According to the international standard guidelines, upper margin-reflect distance should be more than 2.5 mm, and the VF has to improve by more than 30% after blepharoplasty [18]. Kosmin et al observed a significant improvement after blepharoplasty where they used similar VF global indexes in their study [19]. However, the objective improvement in the visual field of patients [23].…”

Updates on upper eyelid blepharoplasty

“…Restriction in the visual fields due to dermatochalasis has been extensively studied and well documented. [ 16 17 18 19 ] There can be many reasons for this restriction. The most common being the mechanical obstruction of the visual fields due to overabundance in the redundant eyelid tissue.…”