Acute Primary Angle Closure after Peri-Orbital Facial Procedures; Report of 4 cases and Literature Review

Purpose: Literature includes 5 previous reports of acute primary angle closure (PAC) after blepharoplasty and blepharoptosis procedures. The aim of this study is to report 3 more cases of PAC after blepharoplasty and 1 after endoscopic forehead lifting procedures (2003-2016) and review the previous reported cases in the literature to find the risk factors.Methods: Four female subjects with age range of 50-67 years developed PAC 2-5 days after blepharoplasty and endoscopic forehead lifting procedures. All presented with pain, nausea, blurred vision, red eye and eyelid swelling. Diagnosis was delayed in the first subject because of considering the signs and symptoms as usual post-operative ones. Presumed risk factors for the PAC were female gender (all), advanced age (all), pupillary dilation (all), and hyperopia (case 2).Results: Medical treatment controlled the pressure which was followed by bilateral YAG Laser iridotomy. They fully recovered with no optic neuropathy in their last follow up examination 10 months to 10 years after the procedures.Conclusion: Risk of PAC should be investigated preoperatively and its presentation should be considered in the post-operative follow up of subjects with peri-orbital facial procedures.