Management of eyelid retraction related to thyroid eye disease

Abstract

Eyelid retraction related to thyroid eye disease (TED) is a challenging condition. It is one of the main clinical signs and a major diagnostic criterion in TED. This condition may threaten vision due to exposure keratopathy, in addition to its esthetic alterations, which may lead to psychosocial implications and affect the patient's quality of life. Although it is more commonly observed in the upper eyelid, it may be present on both the upper and lower lids. Numerous surgical and nonsurgical treatment modalities have been described and will be reviewed in this article. Management should be based on an individual patient assessment, taking into consideration the disease stage, severity, and clinician experience.

Surgery in Thyroid Eye Disease

“…To correct the upper eyelid retraction, there are numerous surgical techniques, including full-thickness blepharotomy, muller muscle recession or excision, anterior or posterior levator recession with or without adjustable sutures, and use of spacer grafts 73–76…”

“…To correct the upper eyelid retraction, there are numerous surgical techniques, including full-thickness blepharotomy, muller muscle recession or excision, anterior or posterior levator recession with or without adjustable sutures, and use of spacer grafts. [73][74][75][76] The most common technique is a full-thickness blepharotomy, which can be performed percutaneous (anterior) or transconjunctival (posterior). 1 Henderson, in 1965, 77 described a transconjunctival partial-thickness blepharotomy consisting of a supratarsal conjunctival incision followed by Muller muscle transection with or without levator aponeurotomy.…”

“…88 The risk of this complication may be reduced by injecting low volume and high concentration of botulinum toxin in 2 points, at the medial and lateral one-third of the superior tarsal border into the horn of the levator aponeurosis, through a transconjunctival approach. 73 Hyaluronic acid (HA) is also used to manage mild cases of upper eyelid retraction, preferred to treat minor asymmetries or as an alternative to treat residual flare after surgery. Its effect can last from 6 to 12 months in the periocular region and if reversal is necessary, it can be performed using hyaluronidase.…”

“…These types of grafts have several advantages: their size is customizable, they do not require a donor site, are easy to handle, have low complication rates, and enhance wound-healing response by retaining connective tissue components that offer structural support. 73,92,93 The disadvantages are that they tend to contract more and may be associated with a higher resorption rate. 92 The complications that have been reported with the use of this type of materials are cyst formation, chemosis, infection, pyogenic granuloma, aberrant nerve regeneration, and corneal abrasion.…”

“…The most common complication is a transitory ptosis, regressing spontaneously in 1 to 8.5 weeks 88. The risk of this complication may be reduced by injecting low volume and high concentration of botulinum toxin in 2 points, at the medial and lateral one-third of the superior tarsal border into the horn of the levator aponeurosis, through a transconjunctival approach 73…”