Levator recession with adjustable sutures for correction of upper eyelid retraction in thyroid eye disease

To examine the outcome of levator muscle recession with adjustable sutures for correcting upper eyelid retraction in thyroid eye disease.

All patients treated at Haukeland University Hospital between 2001 and 2011 were invited to participate in a follow-up examination. Preoperative measurements were obtained from medical records. The following parameters were recorded: eyelid aperture, the distance from limbus to eyelid margin, vertical motility of the eyelid in up- and downgaze, lagophthalmos, proptosis, vertical motility of the eye, and strabismus. Symmetry and eyelid contour were evaluated from photographs. Results were categorized as good, acceptable or unacceptable.

Sixty-four out of a total of 80 patients attended the follow-up examination. Six were excluded from further analysis due to relapse of their thyroid eye disease with increased inflammation. Among the 58 remaining patients, a good result was observed in 34 patients, an acceptable result in 19 and an unacceptable result in 5. Lagophthalmos was seen in 30% of the lids preoperatively and in 7% postoperatively. A second procedure was performed in 13/80 patients, in 6 because of under-correction and in 7 because of ptosis. Wound infection occurred in 2 patients.

Levator recession with adjustable sutures can be used to correct any degree of retraction. Good results can be obtained, but the procedure is time-consuming, and patients must be informed about the risk for reoperation.