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    Tracking infection source after blepharoplasty

    Infections infrequent with or without ointment; community-acquired MRSA may be culprit


    In the bacitracin group, 3.65% of patients had an allergic reaction. Symptoms included bilateral erythema, edema, and itching. All cultures were negative. Once the ointment was discontinued, patients improved. Only 1 of the 384 patients had an infection, which turned out to be a unilateral non-MRSA infection. The patient received oral antibiotics, Dr. Alford said.

    In the lubricant eye ointment group, 10 (6.3%) of patients had an infection. All infections were culture-positive for community-acquired MRSA. Nine of 10 infections were bilateral; after 158 patients, the study was discontinued.

    Patients with community-acquired MRSA had their sutures removed and were given oral antibiotics, according to their culture.

    “All resolved without sequelae, but patients were left with hypertrophic scarring,” he said.

    Dr. Alford did a further analysis of patients with infection and found an average age of 68.2 years old; two had diabetes, there were no smokers, and there were no previous Staphylococcal infections. The center’s infection rate was only 0.2%, and he and other surgical staff were tested for MRSA but tests were negative.

    So, Dr. Alford wanted to know why were there so many MRSA cases.

    “It’s not unexpected,” he said. “It’s virulent, diverse, and epidemic in the United States. It’s increasing every year. I expect the source was postoperative wound contamination from a community source or self-inoculation from a nasal cavity.”

    Dr. Alford concluded that allergic reactions to bacitracin were a little lower than the 8% reported before in the dermatology literature. He also said postoperative infections are uncommon with/without ointment but if they do occur, suspect community-acquired MRSA.

    This research was not meant to promote any particular antibiotic but to encourage further investigation of this topic, he said.


    1. Alford M. Infection rates comparing topical antibiotic versus antibiotic free ointment in blepharoplasty surgery. Am J Cosm Surg. 2015;32:149-153.



    Mark A. Alford, MD

    E: [email protected]

    This article was adapted from Dr. Alford’s presentation at the 2016 meeting of the American Academy of Ophthalmology. He did not indicate any financial interest in the subject matter.

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