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

Abstract

Background A turn-over septal flap has been reported as a spacer for levator lengthening in a single case report. This study reports the preliminary outcomes of this technique in a series of patients with upper-lid retraction (ULR) associated with thyroid eye disease (TED) causing symptomatic exposure keratopathy (EK). Methods Retrospective, multicenter study of 12 eyelids of 10 patients with TED undergoing a transcutaneous levatorlengthening technique using the reflected orbital septum (OS) as a spacer. Change in palpebral aperture (PA) and contour, position of the skin crease (SC), symptoms of EK, and complications were recorded. Results The average age was 47.5 years. Two patients were excluded, as their septa were found to be very thin at surgery. At an average of 13 months postoperatively, the PA was reduced by 2.5 mm on average (Po0.001) and was within 1 mm of the contralateral eyelid in 11 cases (92%); the position of the SC was within 1 mm of the desired position in all cases. EK resolved in all cases. Complications included one case of overcorrection and one case of recurrent lateral flare. Conclusions The turn-over orbital septal flap technique may be a viable option as an autogenous spacer for the treatment of ULR in TED. This technique may be possible in cases where the OS has been opened by previous surgery but may not be feasible in patients in whom the septum is very thin.

Management of eyelid retraction related to thyroid eye disease

“…Numerous surgical techniques to treat TED-related UER have been described, aiming to obtain predictable and satisfactory postoperative eyelid contour and height, including full-thickness blepharotomy, Mueller's muscle recession or excision, anterior or posterior levator recession with or without adjustable sutures, use of spacer grafts, levator lengthening by marginal myotomy, castellated levator aponeurotomy, orbital septal flap, and medial transposition of the lateral horn of the levator aponeurosis. [ 7 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 ]…”

“…The use of spacers to lengthen the levator palpebrae superioris muscle has been reported. [ 43 44 ] Watanabe et al . [ 43 ] described a transcutaneous levator-lengthening technique using the reflected orbital septum as a spacer in TED patients.…”

“…[ 43 44 ] Watanabe et al . [ 43 ] described a transcutaneous levator-lengthening technique using the reflected orbital septum as a spacer in TED patients. The orbital septum is dissected and sutured to the superior one-third of the tarsal plate using two or three 6-0 vicryl sutures to achieve the correct contour.…”

Bovine Acellular Dermal Matrix for Levator Lengthening in Thyroid-Related Upper-Eyelid Retraction

“…However, permanent correction of fibrosis eyelid retraction can only be obtained through surgery [ 4 , 5 ]. Various surgical techniques to correct upper-eyelid retraction have been described, including Müller’s muscle excision, levator recession with or without adjustable sutures, levator marginal myotomy, levator lengthening with or without a spacer graft, and full-thickness blepharotomy [ 6 – 14 ]. However, many authors have not sorted their cases according to disease severity.…”

Dermis-Fat Graft for Correction of Recurrent Severe Upper Eyelid Retraction in Graves’ Orbitopathy

“…Residual retraction is treated with blepharotomy, upper eyelid retractor recession and grafting ( 2 - 4 ). In marked upper eyelid retraction of 4 mm or more, a spacer may be indicated, many of which have been described ( 5 - 8 ). Dermis-fat graft has been proven to be a useful replacement tissue for eyelid and orbit reconstruction ( 9 , 10 ).…”