title: Risk of dry eye after mullerectomy via the posterior conjunctival approach for thyroid-related upper eyelid retraction.
abstract: BACKGROUND
  Mullerectomy by a conjunctival approach is an excellent way to reduce thyroid-related superior lid retraction. Especially the lateral horn of the levator, into the lacrimal gland, has to be reduced. Alterations in lacrimal secretion have been hypothesized, but never studied.
  
  
  METHODS
  The basal and reflex Schirmer test and functional status were studied in 39 patients with thyroid-related orbitopathy after mullerectomy by a conjunctival approach (12 functional, 27 cosmetic indications). In 24 patients, the results could be compared with those of other measures carried out pre- or postoperatively or, in case of unilateral surgery, the operated and non-operated sides were compared.
  
  
  RESULTS
  The Schirmer test was reduced in 7 of 12 functional cases and in 4 of 27 cosmetic cases. Although tear production was reduced, only two patients had to have increased dosages of artificial tears and two other patients required punctum plugs. Among the 12 functional indications, 10 showed an improved corneal surface.
  
  
  CONCLUSIONS
  Lacrimal production may be reduced after mullerectomy by the conjunctival approach. Nevertheless, the clinical risk is low in comparison with the functional and cosmetic results of the procedure. At present, we try to identify and preserve the lacrimal ostia during surgery.
authors.affiliation: CHU Nancy-Brabois, Vandoeuvre Nancy, France. jl.george@chu-nancy.fr
authors.forename: J-L
authors.initials: JL
authors.lastname: George
authors.forename: M-E
authors.initials: ME
authors.lastname: Tercero
authors.forename: K
authors.initials: K
authors.lastname: Angioï-Duprez
authors.forename: T
authors.initials: T
authors.lastname: Maalouf
mesh_terms: D019882:Blepharoplasty / Q000009:adverse effects*; D003228:Conjunctiva / Q000601:surgery; D015352:Dry Eye Syndromes / Q000209:etiology* / Q000378:metabolism; D005141:Eyelid Diseases / Q000209:etiology / Q000601:surgery*; D005143:Eyelids / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D012307:Risk Factors; D013666:Tears / Q000378:metabolism