BACKGROUND: Postoperative eyelid edema is a common sequelae of ptosis repair, blepharoplasty, and ectropion repair. Generally, periorbital swelling begins in the operated area, reaches its peak at 48–72 hours, and subside within a few weeks. If edema fails to resolve within weeks or months, this could lead to long-term effects on aesthetic or functional outcomes. As a result, identifying risk factors for postoperative swelling could guide physicians on how to prevent and manage these complications. The purpose of this study was to investigate the demographic and physiological variables associated with prolonged eyelid edema.
METHODS: A multi-institution retrospective chart review was performed of all patients who underwent ptosis repair, external levator advancement, blepharoplasty, or ectropion repair between January 2014 and January 2021. Postoperative photos were evaluated using a previously established scale for the rating of postoperative eyelid swelling, in which the grade of edema ranges from 0 (no edema) to 3 (most edema conceivable). For each patient, up to three postoperative photos were evaluated on the grade of edema by three independent physician reviewers, and the three data points collected from the reviews was averaged for each photo. Then, the maximum mean edema grade (MMEG) was determined in order to quantify the most severe phase of swelling for each patient. The edema was stratified as mild (1 < MMEG < 2), moderate (2 < MMEG < 3), and severe (MMEG = 3). Demographic variables were analyzed by chi-square test, one-way ANOVA, and student t-test.
RESULTS: Of the 466 patients who underwent an eyelid procedure, there were 103 patients who had postoperative edema that was evaluated to have an MMEG of 1 or higher. An estimated 35 patients had mild edema (1 < MMEG < 2), 44 patients had moderate edema (2 < MMEG < 3), and 24 patients had severe edema (MMEG = 3). The results of the chi-square analysis demonstrated that there was a significant association between ethnicity and degree of postoperative swelling (***P < 0.0001). The one-way ANOVA indicated that there was a significant difference in maximum mean edema grade (MMEG) across the racial and ethnic populations included in the study (*P < 0.05). In addition, the data indicated that Asian patients (1.98 ± 0.81) had significantly higher edema grades than White patients (1.35 ± 0.78) and when compared using student t-test (**P < 0.001).
CONCLUSIONS: In patients undergoing an eyelid procedure, the degree of postoperative eyelid swelling was significantly associated with ethnicity. In addition, patients of the Asian population demonstrated significantly higher grades of eyelid edema compared with those of the White populations.