Thyroid eye disease also known as Graves' ophthalmopathy can cause severe eyelid retraction. This can result in severe dry eyes and visual impairment. This patient who was treated for Graves' disease has eyelid retraction for the past 3 years. Despite regular use of artificial tear, the eyes were always uncomfortable. She previously had botox rejection to lower the eyelid but find this costly as the procedure was repeated every 2 to 3 months. There are different ways of correcting the retraction depending on the severity, in this case I performed full thickness upper lid recession as shown below.
Severe right upper lid retraction.
The skin crease (site of the double eyelid) is marked.
Skin incision is made along the marked line.
A vertical incision is made deep to the conjunctiva and extended
along the whole length.
A button hole is made in the conjunctiva.
The conjunctiva is cut and extended along for 2/3 of its length
on the lateral side.
The height is assessed to make sure the eyelid cover the top part
of the cornea.
Only the is closed with 6/0 nylon.