Corneal perforation during laser assisted blepharoplasty

Abstract

PurposeBlepharoplasty is one of the most commonly performed oculoplastic prodecures. Laser‐assisted blepharoplasty has been performed for several years with some advantages but also it has many complications. We describe two cases of corneal perforation developed during laser assisted blepharoplasty.MethodsTwo patients were referred to our clinic for complaints about decreased visual acuity. They presented with decreased vision, pain and photophobia of their left eye after laser‐assisted blepharoplasty. Both patients had a visual acuity of 20/400 in the affected eye and showed intraocular pressure as low as 5 mmHg. Slit‐lamp examination revealed Seidel‐positive corneal perforation surrounding corneal opacity with corneal folding. The anterior chamber was shallow with mild intraocular inflammation. Application of cyanoacrylate glue to the perforations was done and therapeutic lenses were replaced. Patients were treated with topical antibiotics and artificial tears four times a day.ResultsOne week after the injury, the IOP was elevated within normal range and intact epithelium without leaking was confirmed by slit‐lamp examination. One month later, the visual acuity was regained and subepithelial and stromal corneal opacity was found without inflammation or leaking. And anterior segment optical coherence tomography revealed deep stromal corneal opacity.ConclusionsCorneal perforation during laser blepharoplasty seems probable with eyelid perforation by the laser beam. So during surgery, metal corneal protectors were placed, but corneal perforation could be developed because a Bell's phenomenon with elevation of the cornea superior to the corneal shields. Therefore, to prevent eyelid and corneal perforation, degree of laser power and exposure must be checked carefully.