Modified levator aponeurosis recession for upper eyelid retraction in Graves' disease

Recession of the levator aponeurosis has proved to be an excellent operation to correct upper eyelid retraction in Graves' disease. Harvey and Anderson's original description included recession of the levator aponeurosis along its entire width and complete extirpation of Müller's muscle. In a modification of the technique, we recess only the lateral two thirds of the levator/Müller's complex. Also, rather than excising Müller's muscle, we simply recess it en bloc with the levator aponeurosis. The lateral horn of the levator is cut, as previously advocated, to relieve the marked temporal elevation of the eyelid characteristic of Graves' lid retraction. This modified procedure provides good upper lid lengthening, with less surgical manipulation, less bleeding, and avoids medial over-corrections. Of 22 upper lids (12 patients) treated with this procedure, 19 (86.3%) were considered "good" after the operation.