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Victor M. Elner, MD, PhD; Adam S. Hassan, MD; Bartley R. Frueh, MD

Arch Ophthalmol. 2004;122:55-60.

Background  A chief morbidity of Graves eye disease is upper eyelid retraction that results in exposure keratopathy and cosmetic deformity.

Objective  To assess the efficacy of graded anterior blepharotomy to treat upper eyelid retraction.

Methods  Fifty eyelids of 32 patients with Graves eye disease–associated upper eyelid retraction, causing symptomatic ocular exposure, were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, lagophthalmos, and keratopathy were compared.

Results  At a mean ± SD of 8.5 ± 8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P<.001), lagophthalmos (P<.001), and keratopathy (P<.01) were significantly improved. Mild contour abnormalities (all 1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative eyelid crease measurements. Complications of ptosis, wound dehiscence, and a full-thickness hole each occurred once. The mean ± SD time taken to perform the procedure was 31.5 ± 8.9 minutes per eyelid.

Conclusions  Graded anterior blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic Graves eye disease. This technique achieves excellent functional and cosmetic outcomes.

From the Department of Ophthalmology, University of Michigan, Ann Arbor. The authors have no relevant financial interest in this article.

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