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Updated: May 17, 2026

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Published on: September 13, 2020

The Tie retraction syndrome.

Gerd Geerling¹, Birte Neppert, Bridget Hemmant

¹Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany. geerling@med.uni-duesseldorf.de

Orbit (Amsterdam, Netherlands)

|October 24, 2012

Summary

A newly identified Tie retraction syndrome (TRS) involves progressive shortening of tie length and increased distance from tie tip to belt buckle. This condition, affecting men more than women, increases with age and income, and requires medical and surgical management.

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Last Updated: May 17, 2026

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Published on: January 13, 2026

Area of Science:

Ophthalmology
Pathophysiology
Syndromology

Background:

Tissue retraction is a known factor in ophthalmic disorders.
A novel retraction syndrome, termed Tie retraction syndrome (TRS), is described.
This syndrome has not been previously reported in ophthalmic literature.

Purpose of the Study:

To describe the clinical characteristics, epidemiology, and pathophysiology of TRS.
To introduce a new grading scheme for TRS diagnosis and management.
To raise awareness of this prevalent and cosmetically disfiguring condition.

Main Methods:

Clinical case description and analysis.
Epidemiological data collection and review.
Proposed grading scheme for diagnosis and management.

Main Results:

TRS characterized by pseudovertical shortening of tie length and horizontal extension of girth length.
Pathognomonic features include increased tie tip to belt buckle distance and subumbilical fat pad prolapse (SUFP).
Syndrome shows male preponderance, increasing incidence with age and income.

Conclusions:

TRS is an abundant, often undiagnosed condition with significant cosmetic implications.
A proposed grading scheme aids in diagnosis and management.
Further discussion and expert commentary are invited regarding this syndrome.