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In reply

We thank Dr Ettl for sharing his experience correcting upper eyelid retraction in Graves eye disease during his fellowship with Dr Koornneef in 1995.

We would like to comment on some issues he raised. When we used the term "eyelid height" in the article, we defined it in the "Methods" section as the measurement from mid pupil to the upper eyelid margin with the eye in primary gaze and the patient’s head perpendicular to the floor. Margin-reflex distance is one specific way of measuring this aspect of upper eyelid height with a flashlight reflex providing the center of the pupil. This method was not consistently used for measuring these patients.

Drs Elner and Frueh each heard Dr Koornneef’s lecture on June 10, 1999, and independently began using the identical methodology, which each understood as what Dr Koornneef recommended. Whether he changed his methodology between 1995 and 1999, expressed . . . [Full Text of this Article]

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

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Koornneef’s Graded Upper Lid Lengthening in Graves Disease
Armin Ettl
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