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Visual disturbance after upper (eyelid) blepharoplasty is a relatively common postoperative complaint. Recent ophthalmology literature has demonstrated alternations of corneal curvature after procedures that reposition the upper eyelid using corneal topography. Astigmatic changes induced by eyelid repositioning may be a cause of persistent blurred vision after upper eyelid procedures. This observation has not been reported in the facial plastic literature.To determine the incidence of persistent visual disturbance after upper blepharoplasty.A retrospective review of upper blepharoplasty by 1 facial plastic surgeon and 2 oculoplastic surgeons during the year 2000. Patient interviews were conducted via telephone.A total of 146 patients were identified, and 106 of them responded to the study request. Six patients (5.7%) had subjective visual acuity changes 1 year after upper blepharoplasty, and 4 of the 6 patients had combined blepharoplasty and ptosis repair. Three patients had worse vision, 2 had improved vision, and 1 was unable to wear rigid contact lenses because of fogging.Prior studies have shown that most patients have measurable astigmatic changes 3 months after blepharoplasty and ptosis repair. We found that only a small percentage of them have persistent subjective symptoms 1 year postoperatively. It is important for facial plastic surgeons to properly advise patients, especially those with combined procedures, that upper eyelid repositioning procedures may induce long-term vision changes. Patients may need to obtain new prescription spectacles and contact lenses postoperatively.