will only protect the area it covers. It is possible for the conjunctiva, sclera, and/or cornea to be lacerated without perforation. Seidel testing can be performed to evaluate for a leak of aqueous or vitreous humor from the wound. Seidel testing involves applying topical flourescein to the cornea and then viewing the cornea with a cobalt blue light. In a positive Seidel test, a “waterfall” within the flourescein is seen emanating from the wound. However, puncture wounds can be self-sealing. Therefore, an ophthalmic evaluation should be performed in the event of any suspected perforation, laceration, or rupture.

Surgical Management

Globe rupture is an ophthalmic emergency; if suspected, any procedure and manipulation of the eye should immediately be stopped. Broad-spectrum antibiotics are given topically and intravenously, and an eye shield placed over the eye. An ophthalmic evaluation must be performed immediately with emergent surgical intervention if indicated.

11.2.2.3 Corneal Abrasion

Corneal abrasions are related to inadvertent damage to the corneal epithelium during surgery from harsh sterilization chemicals, exposure and drying, or mechanical abrasion. In addition, in the absence of direct corneal damage, an abrasion can result from general anesthesia as the cornea is exposed when the patient is insensate and unable to blink. Patients can experience eye pain, discomfort with blinking, foreign body sensation, photophobia, tearing, or decreased vision. The abrasion is diagnosed by symptoms and instillation of topical flourescein to the cornea. The cornea is then evaluated under cobalt blue light. If a corneal abrasion is present, the flourescein will stain the site of injured corneal epithelium [18]. Undiagnosed, or improperly treated, corneal abrasions can progress to corneal ulceration, scarring, or perforation, with associated visual loss.

Medical Management

Corneal abrasions usually heal rapidly, but patients should be medically managed to prevent corneal infection and to control pain and discomfort. Once the diagnosis of corneal abrasion is made, the patient should be seen by an ophthalmologist and treated accordingly with the application of ophthalmic antibiotic ointment or drops, and corneal coverage with a contact lens or patching. The patient is followed daily, and the abrasion typically resolves within 24–48 h depending on its size.

Surgical Management

In the unlikely event that a corneal abrasion results in scarring or opacification, or progresses to an ulcer, the patient should be referred to a corneal specialist for evaluation and treatment. A delay in referral should be avoided as surgical intervention, such as a patch graft or corneal transplant may be required.

11.2.3 Infection

Infection after blepharoplasty is exceptionally rare, occurring at a rate of approximately 0.04% [19]. Periocular infection can be divided into preseptal and orbital cellulitis. Preseptal cellulitis, also known as periorbital cellulitis, is infection that is confined to the eyelid skin and subcutaneous tissues anterior to the orbital septum (Fig. 11.4). On examination the eyelids are warm, edematous, erythematous, and tender to palpation. The extraocular motility is normal, and there is no proptosis. The most common organisms causing preseptal cellulitis are Streptococcus pyogenes, Staphylococcus aureus, and Haemophilus influenza type B [20]. Suture abscess is a mild expression of preseptal cellulitis (Fig. 11.5).

Fig. 11.4 Preseptal cellulitis. Note erythematous eyelid skin. No signs of orbital involvement were noted

Fig. 11.5 Suture abscess evident to the nasal upper lid