Late complications of nylon suture blepharoplasty causing ocular surface injury

Background: There are several known ocular complications of suture blepharoplasty which includes suture exposure, cyst formation, and surgical site infection. Objective: To present late complications of nylon suture blepharoplasty that causes damage to the ocular surface. Methods: Medical records of patients who developed ocular surface injury at least 1 year after nylon suture blepharoplasty were reviewed. Results: A total of 9 eyes (3 right and 6 left) of 9 patients (all females) were included in this study. All patients underwent trans-tarsal nylon suture blepharoplasty. The average age of the patients was 36.2 years (range: 22-64 years). The average interval between suture blepharoplasty and revision surgery was 9.6 years (range: 5-15 years). The mean follow-up period after revision surgery was 17 months (range: 7-48 months). Before revision surgery, all patients had reported ocular discomfort. Slit lamp examination revealed ocular surface injury caused by the presence of granulation tissue in the palpebral conjunctiva and deformity of the tarsal plate. Intraoperatively, suture exposure was absent in all but one eyelid. All of the symptoms completely disappeared postoperatively. Conclusion: Late complications of nylon suture blepharoplasty such as granulation tissue formation and tarsal plate deformity cause damage to the ocular surface. The trans-tarsal technique and hydrolytic denaturation of nylon sutures were considered as the main contributory factors leading to the mechanisms of ocular surface injury. Level of Evidence: Level IV, case series