Interventions for Reducing Bleeding and Swelling in Blepharoplasty: A Systematic Review
Author: Asim Albishry
Base Hospital / Institution: Department of Ophthalmology, Jeddah Eye Hospital, Jeddah, Saudi Arabia
Abstract ID: 25-143
Purpose
this review aims to highlight evidence-based strategies for minimizing postoperative ecchymosis and edema, ultimately enhancing patient outcomes and recovery in eyelid surgery.
Methods
A comprehensive literature search in Embase, MEDLINE, Cochrane Central, and Google Scholar was performed through August 2024 to identify randomized controlled trials evaluating interventions to reduce edema and ecchymosis in blepharoplasty. The Cochrane Risk of Bias 2 tool was used to assess study quality. Outcome measures primarily included postoperative edema and ecchymosis.
Results
A total of 29 RCTs involving 2,287 patients were included. The most effective intervention for reducing ecchymosis was tranexamic acid, which had significantly lower scores on postoperative day 1 and day 7 across multiple studies. Surgical techniques preserving deep vascular structures significantly reduced edema and hematoma. Skin-only excision caused less swelling than skin plus orbicularis oculi muscle excision. CO₂ laser-assisted blepharoplasty demonstrated superior hemostasis and lower postoperative chemosis. Magnesium sulfate wet dressings provided superior edema reduction compared to ice packs. Cold compresses effectively controlled swelling but offered no long-term benefit. Anesthesia modifications, such as pre-cooling and buffered lidocaine, significantly reduced injection pain yet showed inconsistent effects on postoperative swelling. Alternative therapies, including Arnica Montana and Bromelain, failed to show significant reductions in edema or ecchymosis. Pulsed electromagnetic field therapy showed mild benefits in erythema reduction but did not affect swelling.
Conclusion
TXA, vessel-preserving surgical techniques, and magnesium sulfate dressings are among the most effective interventions for minimizing postoperative edema and ecchymosis in blepharoplasty. CO₂ laser demonstrated superior hemostasis with reduced postoperative chemosis. Herbal remedies and some adjunctive methods showed limited or no benefit. Further trials are still required to identify possible interventions.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Anas | Alamoudi | Department of Ophthalmology, Jeddah Eye Hospital, Jeddah, Saudi Arabia |
| Ahmed | Alnabihi | College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia 3 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia |
| Waleed | Batais | College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia 3 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia |
| Abdulaziz | Aldahlawi | College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia 3 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia |
| Mohammad | Karam | Department of Ophthalmology & Visual Sciences, McGill University Health Center (MUHC), Montréal, Canada |
| Christian | El-Hadad | Department of Ophthalmology & Visual Sciences, McGill University Health Center (MUHC), Montréal, Canada |
