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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 meanϮSD of 8.5Ϯ8.1 months' (range, 2-35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (PϽ.001), lagophthalmos (PϽ.001), and keratopathy (PϽ.01) were significantly improved. Mild contour abnormalities (all Յ1 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 meanϮSD time taken to perform the procedure was 31.5Ϯ8.9 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.

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