Abstract
A 67-year-old male had suffered from eye movement disturbance from Graves’ orbitopathy. His right eye was fixed in an esotropic position. Examination by synoptophore showed that his right eye deviation was 22 degrees medially. The upper eyelid margin reflex distance (MRD) was 3.5 mm OD and 5.6 mm OS, and the lower eyelid MRD was 5.1 mm OU. Six mm medial rectus muscle recession with tenotomy was performed in the patient. The next day after the surgery, his eye position did not change and the right eyelid fissure demonstrated narrowing with upper eyelid lowering and lower eyelid elevation. The right upper eyelid MRD was decreased to 1.9 mm and the right lower eyelid MRD was similarly decreased to 4.3 mm. On the same day, 4 mm resection of the ipsilateral lateral rectus muscle was performed, but the same MRDs were ob-served postoperatively. Patients undergoing medial rectus muscle recession in Graves’ orbitopathy need to be informed of this potential complication.
Highlights
Surgery on the medial rectus muscle is known to have the complication of a change in eyelid fissure height [1]
The right upper eyelid margin reflex distance (MRD) was decreased to 1.9 mm and the right lower eyelid MRD was decreased to 4.3 mm
We report a case with eyelid fissure height narrowing with upper eyelid lowering and lower eyelid elevation after medial rectus muscle recession in Graves’ orbitopathy
Summary
Surgery on the medial rectus muscle is known to have the complication of a change in eyelid fissure height [1]. Recession tends to show widening of the eyelid fissure height, and narrowing which is mostly caused by resection [1]. These results are mainly due to changes in the lower eyelid position, upper eyelid lowering by recession is a rare response [1]. We report a case with eyelid fissure height narrowing with upper eyelid lowering and lower eyelid elevation after medial rectus muscle recession in Graves’ orbitopathy
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