Purpose: To report a case of visual loss to light perception in the right eye after upper and lower eyelid blepharoplasty. Design: Case report. Method: A 46-year-old man was referred 3 days after combined bilateral upper and lower lid blepharoplasty with visual acuity of light perception in the right eye. The fundus examination, fluorescein angiography and magnetic resonance imaging of the orbit were normal. Ocular motility was full in all directions of gaze. Result: The diagnosis of optic nerve damage was initially based on the relative afferent pupillary defect. The diagnosis of a perioperative posterior ischemic optic neuropathy was based on the Goldmann visual field examination and the subsequent optic atrophy. Central visual acuity, color vision as well as the visual field improved markedly within 3 months. Conclusion: Blindness is a rare but feared complication of blepharoplasty and is reported to occur in about 0.04% of cases. Although intraorbital hemorrhage is thought to be the leading cause for optic nerve damage in most of the patients with this devastating condition, we present a case with perioperative posterior ischemic optic neuropathy leading to visual loss after blepharoplasty. The mechanism leading to optic nerve damage in this patient may include compromised small arteries perfusing the optic disk due to direct mechanical compression and a probable vasoconstrictive activity of the anesthetic agent.

Iatrogenic causes should be considered in the differential diagnosis of orbital inflammations, scleritis and uveitis. Findings are mostly reversible after discontinuation of the drug and therapy of inflammation.

The association of sinusitis with ocular motility disorders is a seductive theory due to their close anatomical vicinity. Typically, sinusitis can influence ocular motility by affecting single muscles or a combination of muscles and/or cranial nerves due to a local inflammatory tissue reaction. Although rare, sinusitis has been suggested at least as a cause for superior-branch oculomotor palsy. We report a case of progressive, isolated, third-cranial-nerve palsy caused by an aneurysm of the posterior-communicating artery that initially was thought to be related to pansinusitis.

The outcome evaluation after a long-term follow-up showed amazingly stable results compared to the follow-up after one year. With a more aggressive dosage we could have achieved more orthophoric results, but also more undesirable overcorrections.

SFT are rare mesenchymal tumours of the orbit. The radiological differential diagnosis is difficult and they can be mistaken for more common tumours. The SFT has a wide range of histological appearances. Long term clinical follow-up is mandatory in all cases of SFT.