By John Alva Long
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Sample text
The orbital fat should be visualized beneath the septum to prevent damage to the underlying levator aponeurosis.  Clinical pearl Clinical pearl: Closure of the eyelid septum is contraindicated in blepharoplasty surgery. The septum is attached to the superior orbital rim and to the levator aponeurosis. Closing the septum will produce an undesirable contour of the eyelid and may lead to poor lid function. of the eyelid, from the lateral canthus towards the lateral eyebrow. In this area, a deep incision is possible since the levator muscle is not present.
In adults, a cocaine-soaked cotton pledget is placed along the floor of the nose adjacent to the interior turbinate. Cocaine provides both vasoconstriction and topical anesthesia. In children, Neo-Synephrine is substituted for the cocaine. Local anesthesia is injected through the conjunctiva medial to the superior and inferior punctum. Step 2. Punctal dilation: The upper and lower puncta are dilated vigorously to allow the passage of a Crawford stent. Step 3. Crawford stent: A Crawford stent is passed through the punctum, canalicular system and the lacrimal sac.
G Complications The most dreaded complication following blepharoplasty is orbital hemorrhage. While vision loss following blepharoplasty is rare, any orbital bleeding must be recognized and managed effectively. If an orbital hemorrhage develops the wound can be opened and all retained blood removed. Control of the bleeding and management of ocular and orbital pressure are critically important. Over-excision of eyelid tissue during blepharoplasty will lead to a compromise in eyelid function. Lagophthalmos, dry eyes and pain will develop if the movement of the eyelid is compromised.