To report a case of misdiagnosed iatrogenic scleral perforation leading to macular hypotony after upper lid blepharoplasty

A 35-year-old woman presented with complaint of left eye pain and blurred vision since 3 days ago following bilateral upper lid blepharoplasty in the other center. Her visual acuity was counting finger of 2m for the left eye and 20/20 for the right eye. Other ophthalmologic exams were normal in the right eye.

The slit-lamp biomicroscopy of the left eye revealed full-thickness lacerations in the sclera and limbus with a positive Seidel test. The anterior chamber was shallow and the eye was hypotonic. In the fundoscopy, wrinkling of the macula was apparent consistent with the diagnosis of hypotony maculopathy which was confirmed by ocular coherence tomography (OCT). She was admitted and underwent the primary repair of the scleral and limbal laceration. Her visual acuity and other symptoms improved significantly during one week after surgery.

Hence, although it is so rare, the surgeons should be aware about the possibility of ocular penetrating injury as a complication of blepharoplasty and be concerned about its symptoms and signs such as disproportionate pain, visual lass, a hypotonic globe and corneal clouding