Friday, August 11, 2017

A hyperthyorid patient with eye protrusion and severe dry eyes.

Hyperthyroidism is associated with ocular changes which can cause eye protrusion and severe dry eyes. This patient developed hyperthyroidism three years ago. Despite medical control of the condition, she noticed her eyes were becoming more protruded with eyelid retraction and frequent tearing that cause blurring of vision.  The tearing was a reflex response to dryness as a result of ocular exposure. In order to reduce the exposure, the lateral aspects of the eyelids were closed surgically (lateral tarsorrhaphy). The operation was performed as followed:

Hyperthyroid patient with ocular exposure due to eye protrusion 
and lid retraction.

Before surgery, the amount of lid closure was determined by closing 
the upper and lower lid laterally.

Before surgery, the amount of lid closure was determined by closing 
the upper and lower lid laterally.

The amount of tissue needed to be removed was marked.

The amount of marked tissue was incised.

The anterior lamella of the eyelid was split to take out the anterior lamella.

The picture showed the tissue removed with the lateral anterior lamella.

The angle of the eyelid was formed with 6/0 vicryl.

The posterior lamella was closed with 6/0 vicryl.

The orbicularis muscle was closed with 6/0 vicryl before the skin 
also with 6/0 vicryl.

Immediately after the procedure.

At two weeks postoperative. The exposure was reduced.