Upper blepharoplasty

In addition to the assessments above, the examination before upper blepharoplasty includes the following elements:

• visual field testing to determine the presence and degree of superior visual field defects (if needed for documentation)

• evaluation of the forehead and eyebrows (including brow height and contour) to detect forehead and brow ptosis; the surgeon should make careful observations when the patient’s facial and brow musculature is relaxed

• notation of the position of the upper eyelid crease

Lower blepharoplasty

Preoperative examination for lower blepharoplasty further includes

• testing of the elasticity (snapback test) and distractibility of the lower eyelid; the surgeon should be alert to the possible need for horizontal tightening of the lower eyelids along with the blepharoplasty

• notation and discussion of prominent orbital rims, if present; malar hypoplasia or relative exophthalmos may predispose the patient to postoperative scleral show after lower blepharoplasty

Figure 12-26 Preoperative marking. A, Typical skin marking for upper eyelid blepharoplasty. After skin marking, there should be at least 20 mm of remaining upper eyelid skin (sum of the distance indicated by the arrows).B, The upper and lower markings are superimposed when the eye is open.

(Courtesy of Bobby S. Korn, MD, PhD.)

Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.