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Arch Ophthalmol. 2004;122:1882-1885.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The treatment of eyelid retraction in Graves disease is one of the most challenging aspects of ophthalmic plastic surgery. There are numerous theories about the etiology of upper eyelid retraction, including overaction of the lid retractor in combination with fibrosis of the inferior rectus muscle, fibrosis of the lacrimal gland and adjacent levator aponeurosis, enlargement of the levator fibers, and increased sympathetic tone in the superior tarsal muscle.^1-4

Several anatomical explanations account for the lateral accentuation of upper eyelid retraction that occurs in Graves disease. In 1980, Grove² noted fibrosis in the lacrimal gland and adjacent lateral levator aponeurosis, perhaps indicative of more lateral eyelid retractor shortening. In 1991, Lemke⁵ noted that the forces that affect the upper eyelid are governed by variations in orbital size and shape, globe size and position, and the length-tension characteristics of the eyelid structures. Enhanced lateral upper eyelid retraction occurs in part because the . . . [Full Text of this Article]

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AUTHOR INFORMATION
Eli L. Chang, MD; C. Robert Bernardino, MD; Peter A. D. Rubin, MD