FIXATION DURESS IN THE PATHOGENESIS OF UPPER EYELID RETRACTION IN THYROID ORBITOPATHY - A PROSPECTIVE-STUDY

Citation
Lm. Hamed et Am. Lessner, FIXATION DURESS IN THE PATHOGENESIS OF UPPER EYELID RETRACTION IN THYROID ORBITOPATHY - A PROSPECTIVE-STUDY, Ophthalmology, 101(9), 1994, pp. 1608-1613
Citations number
33
Categorie Soggetti
Ophthalmology
Journal title
ISSN journal
01616420
Volume
101
Issue
9
Year of publication
1994
Pages
1608 - 1613
Database
ISI
SICI code
0161-6420(1994)101:9<1608:FDITPO>2.0.ZU;2-#
Abstract
Background: Upper eyelid retraction in thyroid eye disease may be caus ed by proptosis, levator and Muller's muscle infiltration with fibrosi s or individual fiber enlargement, excessive sympathetic innervation, abnormal adhesions between levator palpebrae muscle and surrounding ti ssues, or fixation duress. Fixation duress refers to upper eyelid retr action while fixating with an eye with inferior rectus muscle restrict ion due to excessive simultaneous firing of the ipsilateral superior r ectus and levator palpebrae muscles. Methods: The authors prospectivel y examined six patients with strabismus and thyroid eye disease associ ated with inferior rectus restriction and upper eyelid retraction in w hom the eyelid retraction was suspected clinically to be a result of f ixation duress. All six patients underwent recession of both inferior recti ranging from 3 to 6.5 mm (mean, 4.5 mm) to improve the ocular mo tility and alignment, reduce the diplopia, and mitigate the upper eyel id retraction. Results: Reduction of upper eyelid retraction measured as the preoperative versus postoperative difference in corneal light r eflex - upper eyelid margin measurements was achieved in all patients postoperatively, ranging from 1.5 to 5.5 mm (mean, 3.2 mm). Only one p atient showed significant residual retraction to warrant consideration of upper eyelid surgery. Conclusion: Fixation duress plays a signific ant role in upper eyelid retraction of thyroid eye disease in a subset of patients with restriction of the inferior rectus muscle. In this s elected group of patients, the upper eyelid retraction may be reduced or eliminated upon proper recession of the tight inferior rectus muscl e(s).