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Ahn, Lee, Jang, Lee, Sin, and Baek: Clinical Efficacy of Blepharotomy for Upper Eyelid Retraction Associated with Thyroid Eye Disease
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(7): 911-917.

Published online: 13 July 2012

DOI: https://doi.org/10.3341/jkos.2012.53.7.911

Clinical Efficacy of Blepharotomy for Upper Eyelid Retraction Associated with Thyroid Eye Disease

Soh-Eun Ahn, MD1, Hwa Lee, MD, PhD1, Minwook Jang, MD, PhD1, Jongmi Lee, MD2, Hyoungho Sin, MD3, Sehyun Baek, MD, PhD1

1Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

2Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

3Cheonan Kim's Eye Clinic, Cheonan, Korea.

Address reprint requests to Sehyun Baek, MD, PhD. Department of Ophthalmology, Korea University Asan Hospital, #123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea. Tel: 82-31-412-5160, Fax: 82-31-414-8940, shbaek6534@korea.ac.kr

Received 23 December 2011       Accepted 2 June 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To investigate the clinical efficacy of blepharotomy to treat upper eyelid retraction associated with thyroid eye disease.

Methods

A retrospective survey was performed with 9 eyes of 7 thyroid ophthalmopathy patients, who visited Korea University Medical Center from August 2009 to February 2011, and had undergone blepharotomy. The sex, age, change of upper eyelid retraction, postoperative complication, follow-up periods, and the surgical results were reviewed. To assess the efficacy of blepharotomy more objectively, the preoperative and postoperative pictures of patients were taken and the following lid parameters measured: marginal reflex distance 1, interpalpebral fissure height, total palpebral fissure area, upper nasal palpebral fissure area, and upper temporal palpebral fissure area.

Results

The mean age of patients was 37.4 years and mean follow-up period was 12.8 months. Five patients had undergone surgery unilaterally and 2 patients, bilaterally. Seven eyes of 6 patients had undergone full thickness blepharotomy and 2 eyes of 1 patient had undergone graded blepharotomy. According to the 3-month preoperative and postoperative picture analysis, all lid parameters improved significantly after blepharotomy (2.03 mm, 1.95 mm, 24.28 mm2, 12.98 mm2, and 16.21 mm2, respectively). Complications associated with blepharotomy included multiple and high folds in 2 eyes of 2 patients who had undergone full thickness blepharotomy. Re-operation was performed on only 1 eye and the result was satisfactory.

Conclusions

Blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic thyroid eye disease. This technique achieves excellent functional and cosmetic outcomes.

Keywords: Blepharotomy, Thyroid eye disease, Upper lid retraction

Figures and Tables

Figure 1
Pre and postoperative five lid parameters were measured by image J program. Marginal reflex distance 1 (MRD1, distance from the upper lid margin to the center of the pupil), interpalpebral fissure height (IPF, widest distance between the upper and lower lid margins), and total palpebral fissure area (TA) were measured. For defining the upper nasal area (UNA) and upper temporal area (UTA), a straight line connecting the medial and lateral canthi was drawn, and a perpendicular line passing through the center of the intercanthal line was drawn.
jkos-53-911-g001
Figure 2
Intraoperative steps of blepharotomy in a patient with upper eyelid retraction. (A) Skin incision in the marked crease. (B) Meticulous dissection of orbital septum using a Desmarres retractor. (C) Transsection of levator complex and conjunctiva in the lateral third of the upper lid. (D) Upper eyelid after medial and lateral horizontal blepharotomy. (E) Dissection of the lateral horn. (F) Skin closure after tarsal fixation of subcutaneous tissue and skin.
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Figure 3
Improvement of left upper lid retraction after blepharotomy in a patient with thyroid eye disease. (A) Before blepharotomy. (B) After blepharotomy.
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Figure 4
A patient with multiple high folds after blepharotomy. High folds was corrected successfully after re-operation. (A) Before blepharotomy. (B) After blepharotomy. (C) After re-operation for high fold.
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Figure 5
Re-operation procedure for multiple high folds after blepharotomy. (A) Release of scar tissue between orbicularis oculi muscle and septum and levator aponeurosis; arrow indicates the scar tissue. (B) Pull down preaponeurotic fat to suture upper tarsal plate.
jkos-53-911-g005
Table 1
Distribution and differences of preoperative and postoperative MRD1
jkos-53-911-i001

MRD1 = marginal reflex distance 1.

Table 2
Changes in various lid parameters before and after blepharotomy
jkos-53-911-i002

Data are presented as mean ± SD.

MRD1 = marginal reflex distance 1; IPF = interpalpebral fissure height; TA = total palpebral fissure area; UNA = upper nasal area; UTA = upper temporal area.

*Wilcoxon's signed rank test.

Table 3
Postoperative results
jkos-53-911-i003

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