Modified marginal myotomy for thyroid-related upper eyelid retraction

Abstract

The purpose of this study is to report a modified marginal myotomy procedure for thyroid-related upper eyelid retraction using techniques of quantification and contour adjustment for blepharoptosis surgery, of which surgeons have more experience than of upper eyelid retraction surgery. Eleven upper eyelids of ten patients, average age 41.6 years, were operated on. All patients were clinically and biochemically euthyroid at operation without having had progression of eyelid and orbital changes for at least 6 months prior to surgery. Margin reflex distances of upper eyelids (MRD-1; normal, 2.0–5.5 mm) were measured preoperatively and 3 months postoperatively. Upper eyelid contours were also examined before and after surgery. Medial and lateral horns and the distal attachment of levator aponeurosis were incised to produce a levator flap, which was transversely incised in two positions. The edge of the incised levator was fixed on the appropriate part of the tarsus. MRD-1 values were considerably decreased in all cases, ranging from 2.5 to 6.0 mm (average, 3.8 mm). All final MRD-1 results ranged from 2.5 to 5.0 mm (average, 3.4 mm) and the laterality of MRD-1 was within 1 mm higher or lower than the contralateral eyelids, although a patient with bilateral retraction who had only unilateral operation did not show a symmetrical eyelid height to the contralateral one. All eyelids but one showed acceptable upper eyelid contours; the inconsistent eyelid temporally showed nasal flare, but finally acquired a good curvature. Our procedure effectively decreased upper eyelid height with good contour by utilising techniques from blepharoptosis surgery.