A Promising Modified Procedure for Upper Eyelid Retraction-Associated Graves’ Ophthalmopathy: Transconjunctival Lateral Levator Aponeurectomy

Abstract Upper eyelid retraction is a characteristic feature of thyroid eye disease, including Graves’ orbitopathy. In this study, a new surgical technique for correction of lid retraction secondary to Graves’ orbitopathy is described. Sixteen eyelids of patients older than ۱۸ years old underwent surgical correction for moderate to severe lid retraction secondary to Graves’ orbitopathy. In this procedure, levator aponeurectomy was performed via a transconjunctival approach. Upper marginal reflex distance (MRD۱) was measured before the surgery and at ۱ week, ۳ months, and ۶ months after the surgery. MRD۱ was reduced significantly from preoperatively (mean: ۷.۸۴ mm) to ۱ week after the surgery (mean: ۳.۵۹ mm) (P < ۰.۰۰۱). Three and six months after surgery, mean MRD۱ was ۵.۰۹ mm and ۵.۱۰ mm, respectively, showing that lid retraction was improved significantly (P < ۰.۰۰۱). Lateral levator aponeurectomy via the transconjunctival approach is a simple, scar-less, quick procedure that has optimal stable outcome.Â