This middle-aged woman with a past history of hyperthyroidism presented with severe thyroid eye disease. Both eyeballs were constantly depressed due to fibrosis of the inferior rectus muscles (the muscles that are responsible for moving the eyes downwards). And she had severe dry eyes due to eyelid retractions.
Severe thyroid eye disease with both eyeballs being pulled
download and lid retractions.
Inability to look up due to severe contracture
of the inferior rectus.
The depressed eyeballs were corrected by releasing the inferior rectus muscles. Following the squint correction, she was able to see straight without having to constantly elevate her heads. The lid retractions were corrected with botox injection to the levator muscles.
Photos showing steps of inferior rectus recession. a. The eyeball was pulled
upward using a 4/0 silk passed through inferior limbus; b. the inferior rectus
was isolated using squint hook; c. the inferior rectus was released and
d. hang back 4mm from its insertion.
Two days postoperative showing better eyeball position and
reduced lid retraction.
8 units of Botox was injected into the levator via a posterior approach.
Appearance of the eyes 6 days postoperative.
Appearance of the eyes at two-month post-operative. There were some eyelid
retraction. Mullerectomy was recommended but patient was happy to leave as
the eyes were now comfortable.