Full thickness eyelid transsection (blepharotomy) for upper eyelid lengthening in lid retraction associated with Graves’ disease

Hintschich, C
Haritoglou, C

Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany

Correspondence to: Christoph Hintschich Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Mathildenstrasse 8, D-80335 München, Germany; [email protected]

Accepted 01 September 2004

We thank Leo Koornneef, who was a gifted surgeon, but also an excellent teacher to his fellows, for everything he gave us including the idea of this simplified, but very efficient, approach to upper eyelid lengthening according to his motto “Keep things simple.”

Financial interest: none.

British Journal of Ophthalmology 89(4):p 413-416, April 2005.

Aim:

To report on a modified technique for upper eyelid lengthening in lid retraction associated with Graves’ disease.

Methods:

A prospective consecutive interventional case series. 41 patients, 38 women and three men, with a mean age of 55 years (range 32–75 years) were included. Full transsection of the upper eyelid with optional transsection of the lateral horn was performed in 60 lids. A central bridge of conjunctiva was left intact in the pupillary axis. Before and after surgery, the skin crease, palpebral aperture, and scleral show were measured and the contour of the lid margin was assessed. The overall result was graded as “perfect,” “acceptable,” and “failure.”

Results:

The mean period review was 6 months (range 2–36 months). Preoperatively, upper eyelid retraction varied from 1 mm to 7 mm; mean scleral show was 2 mm in 45 lids, the palpebral aperture was in the desired height (SD 1 mm) in 53 of 60 lids (88%) and was reduced by 3 mm (mean), the skin crease remained unchanged (SD 1 mm) in 44 of 60 lids (73%). The result was considered “perfect” in 43 and “acceptable” in 14 of 60 lids after one or two surgical approaches. In three lids, the surgery had failed.

Conclusion:

In contrast with other surgical techniques the surgical approach presented here is easy to perform and still leads to very satisfying and predictable postoperative results.