Outcomes of blepharoplasty for orbital fat prolapse in thyroid eye disease: a clinical study

This study evaluates the functional and aesthetic outcomes of Blepharoplasty for orbital fat bags in patients diagnosed with inactive thyroid eye disease (TED).

A prospective observational study was conducted on 40 patients (72 eyelids) with stable TED undergoing various types of blepharoplasty for visible orbital fat bags between January 2023 and January 2025. Patients were followed for 06 months. The primary outcomes were changes in marginal reflex distance 1 (MRD 1), marginal reflex distance 2 (MRD 2), and patient satisfaction as measured by the Visual Analog Scale (VAS). Measurements were recorded preoperatively and postoperatively on day 1, 1 week, and at 1, 3, and 6 months. The secondary outcomes focused on the occurrence of postoperative complications during the 6-month postoperative follow-up.

MRD 1 increased significantly postoperatively from a mean of 2.42 ± 0.70 to 4.28 ± 0.271 at 6 months (p < 0.001), indicating restoration of upper eyelid position and improved eyelid contour. MRD 2 decreased significantly from 6.04 ± 0.07 to 5.2 ± 0.353 mm (p < 0.001), reflecting correction of lower eyelid bulge. VAS scores improved markedly from a preoperative mean of 2.1 to 8.9 postoperatively (p < 0.001), indicating high patient satisfaction.Minor complications observed were transient chemosis and lid retraction. Asymmetry was noted in 2 eyelids (2.8%), which required revision surgery. No major complications were observed.

All types of blepharoplasty can be safely and effectively used to manage orbital fat prolapse in TED when tailored to the patient's anatomy and disease status. Aesthetic and functional outcomes are excellent, especially with a conservative, anatomy-based approach.