Surgical treatment of dysthyroid eyelid retraction and orbital fat hernia

Upper eyelid retraction secondary to thyroid disease can be relieved in a controlled manner by a graded detachment and excision of Müller's muscle and stripping and recession of the levator aponeurosis. This improves cosmesis, lessens the exophthalmic appearance, and relieves ocular irritation secondary to exposure keratopathy and conjunctivopathy. Recessing the lower eyelid retractors and placing a scleral graft between them and the tarsus can relieve lower eyelid retraction. Edema and inflammation of orbital fat secondary to thyroid disease cause separation of the orbital septum from the capsulopalpebral fascia, allowing fat to prolapse into the orbit as in a true hernia. To prevent full fledged lower eyelid retraction and to relieve slight amounts that already exist, the lower eyelid retractors are recessed when orbital fat is excised.