Surgical Treatment of Eyelid Retraction Associated with Thyroid Eye Disease. J. Justin Older. Ophthalm Surg 1991;22

Turn-over orbital septal flap and levator recession for upper-eyelid retraction secondary to thyroid eye disease

“…Seventy percent of patients (n ¼ 7/10) were euthyroid at the time of surgery and 70% had received steroid treatment for that condition. The average follow-up was 13 months (range [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The indication for eyelid lowering was lagophthalmos in five (42%) (mean degree of lagophthalmos was 1.9 mm (range 1-6.5 mm)), foreign body sensation in eight (67%), photophobia in seven (58%), and symptomatic epiphora in three (25%).…”

“…1,2 These techniques are based on weakening or lengthening the upper-eyelid retractors and include anterior or posterior approaches to graded recession or resection of Mü ller's muscle, [3][4][5] levator aponeurosis (LA)/muscle, [6][7][8] or both, 5,[9][10][11][12][13][14] full-thickness blepharotomy, [15][16][17] levator lengthening by marginal myotomy, 18,19 z-myotomy, 20 castellated levator aponeurotomy, 21 reattachment of the recessed levator to the tarsus by various spacers (sclera, 22,23 mersilene mesh, 24,25 sutures, 26,27 adjustable sutures, 28,29 orbital septal flap, 30 pretarsal soft tissues, 31 and deep temporal fascia 32 ), pedicle tarsal rotation flap, 33 or medial transposition of the lateral horn of the LA. 34 The orbital septum (OS) arises from the arcus marginalis and terminates inferiorly as it attaches to the LA; it can be used as a vascularized turn-over flap to act as a spacer between the recessed LA-Muller's muscle complex-Muller's muscle complex and the tarsal plate.…”

Lateral and Medial Upper Eyelid Contour Abnormalities in Graves Orbitopathy

“…2,[9][10][11] It should be noted that the determination of the highest point of the eyelid contour has not the same meaning as measuring lateral or medial peaks. Until recently, eyelid contours were evaluated subjectively and abnormalities were named as gothic arches, notches, peaks, lateral flare, and so on.…”

Pre- and Postoperative Quantitative Analysis of Contour Abnormalities in Graves Upper Eyelid Retraction

“…1 Most of the affected patients are women who usually have serious concerns about their appearance and in severe cases suffer from dry eye and keratitis. [5][6][7][8][9][10] One of the most important problems of any procedure aimed to correct upper eyelid retraction is how to avoid postoperative contour abnormalities. All techniques published to correct upper eyelid retraction are minor variations of weakening of the levator palpebrae superioris (LPS) and Müller's muscle.…”