Fat adherence simulating inferior oblique palsy following blepharoplasty.

Abstract

Inferior oblique palsy is a reported complication of lower-lid blepharoplasty.1However, a positive forcedduction test result suggests that the cause of the strabismus is restriction rather than palsy. We report a case of hypotropia with restricted elevation of an eye, simulating inferior oblique palsy, following transconjunctival lower-lid blepharoplasty. Report of a Case. —A 37-year-old woman complained of vertical diplopia 5 days after a bilateral transconjunctival lower-lid blepharoplasty for the removal of herniated orbital fat pads. She described marked ecchymosis and edema of both lower lids during the first postoperative week. She had no history of thyroid disease, orbital or head trauma, or childhood strabismus. On examination, her visual acuity was 20/20 in each eye. The pupils were equal in size. The lid fissures were asymmetric with a retracted left lower lid. No upper-lid ptosis was present. A prominent horizontal scar was found in the left inferior conjunctival cul-de-sac. In