Restrictive Horizontal Strabismus Following Blepharoplasty

Purpose To report a case of horizontal diplopia after a four-lid blepharoplasty. Design Observational and interventional case report. Methods Analysis of the history and management of a 64-year-old man who underwent a four-lid blepharoplasty, after which he developed horizontal diplopia. Results The patient was found to have a restrictive esotropia. He underwent a recession of the left medial rectus on an adjustable suture, with recurrence of the same pattern of diplopia one month after surgery. Conclusions The involvement of the extraocular muscles as a complication of blepharoplasty is uncommon, but when it is present, it may be very difficult to treat.