Repair of Eyelid Retraction

• Graves' ophthalmopathy generally causes the eyelids to open more widely. The front surface of the eyeball becomes exposed beyond the eyelids and causes discomfort and excessive tearing; exposure keratopathy.
  
• Eyelid surgery is the most common surgery performed on Graves ophthalmopathy patients.
  
• Lid-lengthening surgeries can be done on upper and lower eyelid to correct the patient’s appearance and the ocular surface exposure symptoms.
• Marginal myotomy of levator palpebrae muscle can reduce the palpebral fissure height by 2-3 mm.
  
• When there is a more severe upper lid retraction or exposure keratitis, marginal myotomy of levator palpebrae associated with lateral tarsal canthoplasty is recommended.
  
• This procedure can lower the upper eyelid by as much as 8 mm. Other approaches include müllerectomy (resection of the Müller muscle), eyelid spacer grafts and recession of the lower eyelid retractors. Blepharoplasty can also be done to debulk the excess fat in the lower eyelid.

• Surgically repositioning the eyelids can reduce the irritation. If orbital decompression, eye muscle and eyelid surgery are required, the eyelid procedure is generally performed as the final procedure in the series.

Upper Eyelid Retraction

• The upper eyelid retraction may possibly be worsened if the eye is unable to raise normally (strabismus), and extra nerve impulses are sent simultaneously to the muscle which elevates the lid and to the muscle struggling to raise the eye itself; once the restriction is treated (e.g. strabismus surgery), the degree of retraction often decreases.

Lower Eyelid Retraction Surgical Step-by-Step Animation

References:

Use of the tarSys® for posterior lamellar grafting for lower eyelid malposition