Indian Journal of Ophthalmology

ORIGINAL ARTICLE
Year
: 1984  |  Volume : 32  |  Issue : 5  |  Page : 371--372

Surgical treatment of thyroid related upper eyelid retraction


Ashok R 
 Department of Ophthalmology, TN Medical College & B. YL Nair Hospital, Mumbai, India

Correspondence Address:
Ashok R
31, Pentacle, Near,Sophia College, B. Desai Road, Mumbai-400 026
India




How to cite this article:
AshokR. Surgical treatment of thyroid related upper eyelid retraction.Indian J Ophthalmol 1984;32:371-372


How to cite this URL:
AshokR. Surgical treatment of thyroid related upper eyelid retraction. Indian J Ophthalmol [serial online] 1984 [cited 2021 Sep 17 ];32:371-372
Available from: https://www.ijo.in/text.asp?1984/32/5/371/27514


Full Text

Endocrine Ophthalmopathy usually is associated with hyperthyroidism, but it can also occur in euthroid & even hypothyroid person as well. Clinical changes progress from upper lid retraction, and exophthalmos through soft tissue involvement and prop­tosis to extraocular muscle involvement, finally the cornea is involved and vision is lost through optic nerve disease.

Local treatment of endocrine ophthal­molpathy includes the instillation of an antibiotic-decongestant, preparation, and the use of local adrenergic blocking agents, par­ticularly guanathedine eye drops. When care­ful control of thyroid dysfunction and other measures including high dose steroids have failed, plastic surgery techniques are avail­able to correct lid retraction.

 MATERIAL AND METHOD



42 consecutive upper lid retraction in patients with thyroid ophthalmology where medical treatment tailed to control the dis­ease, Muller's muscle excision with or without recession of the levator aponeurosis was tried.

Technique

The procedure is illustrated in figure A to I. Subcutaneous Inj . xylocaine 2% with adrenalin 1:1000 given over the centre of upper lid for retraction suture. Then subcon­junctival Inj. Xylocaine 2% with adrenaline 1:1000 is given. Conjunctiva is separated from Muller's muscle. Then Muller's muscle is dis­inserted from temporal two thirds of superior tarsal border. Muller's muscle is separated from levator aponeurosis. Stripping of levator aponeurosis is done. Muller's muscle is excised. Conjunctiva is sutured back to superior tarsal border.

 OBSERVATIONS



35 of the 42 patients yielded excellency cos­metic result The other patients had minor complications which were remedied by further surgery.

 DISCUSSION



This is the preferred treatment of thyroid­related retraction of the upper eyelid. It is relatively simple procedure that is based on the physiological and anatomical nature of the disorder. When the second upper lid is treated, several weeks after the initial opera­tion, the lid should be placed at the same level as to which the first eylid was placed at the operation.