Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Eyelid Surgery in Graves' Disease

Hintschich C. R.
University Eye Hospital Munich

An increase of volume and fibrosis of orbital soft tissues are responsible for the typical pathology in Graves' disease, leading to exophthalmos, extraocular motility disorders, lid retraction and eyelid swelling. Eyelid disese can be corrected functionally and cosmetically with a number of surgical procedures.
Stabilized thyroid metabolism, minimal disease activity and no smoking are pre-conditions for succesful eyelid surgery. Surgical rehabilitation in Graves' disease is performed in stages. Significant proptosis is a poor condition for lid-lengthening procedures and should be corrected before. Extraocular muscle surgery has to be completed before performing eyelid surgery.
Upper eyelid lengthening in patients with Graves´ ophthalmopathy is often difficult, because the results are somehow unpredictable. Not only the desired lid height, but also the lid contour and skin crease can cause unfavourable results. A simplified technique is presented, which avoids some of the above mentioned problems.
Under local anesthesia by a transcutaneous approach all layers of the lid including parts of the conjunctiva are transsected. Final adjustment is performed with the patient sitting in upright position with almost no overcorrection. No traction sutures or spacers are used. The wound is closed with a running locked skin suture. Post-operatively lid height and contour can be modified by pulling and massaging.
In contrast to the upper eyelid, lower lid lengthening usually needs the use of spacers. Autologou

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