Studies2- 4,10 have investigated the effect of eyelids on corneal shape, mainly in congenital ptosis. Gullstrand11 reasoned that corneal astigmatism was changed by the pressure of the eyelids in with-the-rule direction, attributing this to a flattening of the cornea by the eyelids. When the cornea is flattened peripherally, the central cornea becomes steeper in with-the-rule direction. In addition, various upper and lower eyelid conditions, including hemangiomas, gold weight implants, chalazia, epibulbar dermoids, and involutional ectropion, have been reported to affect corneal shape.12- 16 As far as we know, astigmatic change after blepharoplasty has been investigated only marginally. Brown et al2 prospectively evaluated corneal shape changes in 22 patients who underwent upper eyelid surgery. In total, 18 corneas of 9 patients undergoing blepharoplasty and 24 corneas of 13 patients undergoing ptosis surgery were measured by keratometry. At 3 months after ptosis repair, the mean dioptric change as measured by keratometry was approximately 0.60 D, and almost 30% of these patients showed transient astigmatic changes greater than 1.00 D. At 3 months after blepharoplasty, the mean dioptric change as measured by keratometry and by corneal videokeratography was approximately 0.55 D, with 11% of patients showing astigmatic changes greater than 1.00 D. The number of measured eyes was small and blepharoplasty was analyzed as a whole, without differentiating skin-only or additional fat pad reduction. We found a smaller mean dioptric change of 0.19 D after upper eyelid surgery, with mean changes of 0.16 D in the blepharoplasty group and 0.25 D in the ptosis group. Rotation of axis was not systematic and was not predictable. Only 1 of our patients demonstrated a change of more than 1.00 D. This change in refraction was clinically relevant as the patient had noted blurred vision at 3 months after surgery.