RESULTS OF MULLEROTOMY AND LEVATOR APONEUROSIS TRANSPOSITION FOR THE CORRECTION OF UPPER EYELID RETRACTION IN GRAVES-DISEASE

Background: Upper eyelid retraction in Graves disease may cause functi onal morbidity and aesthetic deformity. Surgery to correct thyroid-rel ated upper eyelid retraction may result in temporal undercorrection wi th failure to eliminate lateral eyelid retraction, leading in turn to a poor eyelid contour postoperatively. Methods: In 1984, one of the au thors developed a new procedure for correcting moderate to severe uppe r eyelid retraction associated with Graves disease. The surgical techn ique consists of a Mullerotomy and recession of the levator aponeurosi s combined with medial transposition of the lateral horn of the levato r aponeurosis. The procedure was performed on 37 patients (72 eyelids) . Muller's muscle was used as the spacer to set the eyelid height, Tra nsposition of the levator aponeurosis allowed adjustment of eyelid con tour. Results: Thirty patients (58 eyelids) had excellent results, six (13 eyelids) had good results, and one (1 eyelid) had a poor result. No patient required re-operation for asymmetry, unacceptable contour, or malposition. Only one eyelid had significant overcorrection, and on ly one eyelid had significant undercorrection, requiring further surge ry, The most frequent unwanted effects were high eyelid crease (24 eye lids) and residual temporal flare (6 eyelids); however, most of these were seen early in the series before the lateral levator transposition modification was added. Conclusion: This procedure allows successful and simultaneous correction of both eyelid position and contour in pat ients with moderate to severe thyroid-related upper eyelid retraction.