This woman suffered from hyperthyroidism as a result of Grave's disease a year ago. While she was under treatment, she noticed her eyes became prorgressively more protruding and the upper eyelids began to retract. About 30% of sufferers of Graves' disease will also suffer from Graves' ophthalmopathy that's what this patient had. Her friends and family members were uncomfortable talking to her face to face as she always appears to be staring at them. The retraction of the upper eyelids is giving her a lot of discomfort because of rapid evaporation of the tears. She was forced to use artificial tears hourly.
To improve her appearance and reduce the discomfort, I decided to perform eyelid lowering procedure on her after making sure that her thyroid status and the eyelid retraction were stable. The procedure I used is called müllerectomy which means the removal of Müller's muscle. This is a small muscle of the upper eyelid used to open the eyelid (the other muscle is called levator). Special thanks to Dr. Ting Siew Leng for taking these photos.
Thyroid eye disease with staring eyes due to protrusion
and upper eyelid retractions.
Injection with lignocaine and epinephrine given to
the conjunctiva before operation.
The conjunctiva is cut above the tarsal plate.
The conjunctiva is exposed to reveal the underlying
The Muller's muscle is grasped and dissected from
the conjunctiva and the levator aponeurosis.
More dissection was performed to make sure all Muller's muscle
was included in the removal.
The Muller's muscle is clamped to reduce bleeding
before it was excised.
After removing the Muller's muscle, the conjunctiva is
closed with buried 6/0 vicryl.
The retracted eyelids were lowered at the end
of the operation.