Lid lengthening by sclera interposition for eyelid retraction in Graves' ophthalmopathy

The efficacy of scleral grafts for eyelid lengthening in patients with thyroid related upper and/or lower lid retraction was evaluated in 62 consecutive patients with Graves' ophthalmopathy who underwent lid surgery in the last 3.5 years. Seventy-eight upper and 30 lower lids were lengthened by scleral interposition. A good or acceptable result was achieved in 50% of all operated upper lids after one procedure. This percentage increased to 75% after a second and to 77% after a third procedure. Persistent temporal retraction and nasal overcorrection were the major complications. In lower lid lengthening the success percentage was 90% after one operation. We conclude that scleral grafting for upper eyelid lengthening has no distinct advantage in comparison with other lengthening techniques. Scleral implants to lengthen lower lids are very effective.