Eyelid Surgery in Gravesʼ Orbitopathy

Abstract

Patients with Gravesʼ orbitopathy often develop eyelid changes. These may be the result of a volume effect or a malposition. Both dermatochalasis with fat tissue increase and eyelid retraction may lead to functional or aesthetic impairment. The present article reviews indications, timing and principles for corrective eyelid surgery. If at all possible, surgical eyelid correction in Gravesʼ orbitopathy should be performed once the disease became inactive and stabile. Surgical details of eyelid lengthening procedures for upper and lower eyelid retraction are presented. Meanwhile anterior blepharotomy became the primary procedure for upper eyelid lengthening. However, there is no such standard procedure for lower eyelid lengthening, although it is recommended to use a spacer. For blepharoplasty it is mandatory to distinguish between orbital fat prolapse and subbrow fat pad. A prolapse of the lacrimal gland should not be missed and generally, skin excision performed sparingly.

Observation of Unexplained Cases of Unilateral Upper Eyelid Retraction from Idiopathic Inflammation or an Atypical Form of Gravesʼ Orbitopathy

“…If there is no complete resolution of UER or lid lag, a wait and see regimen is justified for a minimum of 6 months if there is no severe ocular surface disease (OSD). If UER is still persisting, an upper eyelid lengthening by blepharotomy [10,11] can be performed in a quiet stadium. Botulinum toxin or triamcinolone injections might be an option to treat UER [12,13], but were not performed in any of our patients.…”