Eyelid surgery in dysthyroid ophthalmopathy

Dysthyroid ophthalmopathy often gives rise to functional and cosmetic problems due to eyelid retraction. There are several causes of this state which are usually most obvious in the upper lid. Surgery should be delayed until the condition is stable and other operations have been done. A number of operative procedures have been used. In the upper eyelid, the traction of the Müller muscle and, most often, the levator is released; in the lower eyelid, the retractors are recessed or excised. Spacers have been used especially in the lower lid. The retractors can be reached either through the skin or the conjunctiva. Both methods give good results. In the upper lid, the risk of damaging other structures is lower with a skin incision; in the lower lid the conjunctival incision gives easier access to the tissues. The complications most frequently seen are over- or undercorrection both of which may necessitate a reoperation.