title: Transconjunctival Müller muscle recession with levator disinsertion for correction of eyelid retraction associated with thyroid-related orbitopathy.
abstract: OBJECTIVE
  To evaluate the efficacy of transconjunctival Müller muscle recession and graded levator disinsertion for eyelid retraction in patients with thyroid-related orbitopathy (TRO).
  
  
  METHODS
  Retrospective consecutive case series.
  
  
  METHODS
  Medical record review of 78 TRO patients (107 eyelids) who underwent surgery for upper eyelid retraction in a 5-year period was performed. Main outcome measures were anatomic and functional success, minimal reflex distance (MRD), lagophthalmos, eyelid asymmetry, and patient discomfort.
  
  
  RESULTS
  One hundred seven eyelid retraction surgeries were performed on 78 TRO patients (63 women, mean age 49 years); mean follow-up time was 16.7 months. Upper eyelid position, lagophthalmos, exposure keratopathy, and patients' discomfort markedly improved after surgery (P < .001). Marginal reflex distance (MRD1) decreased an average of 2.6 mm from 6 mm pre-operatively to 3.4 mm post-operatively (P < .001); lagophthalmos decreased an average of 0.6 mm from 1.3 mm pre-operatively to 0.4 mm post-operatively (P = .006) Failure rate was 8.4%, most improved with a second surgery. Overcorrection was noticed in three cases (2.8%). Eyelid asymmetry improved from a mean of 1.0 mm pre-operatively to 0.4 mm post-operatively (P = .001); more than 80% of patients showed eyelid asymmetry of 1 mm or less.
  
  
  CONCLUSIONS
  Transconjunctival Müller muscle and levator recession is safe and effective in correction of mild, moderate, or severe eyelid retraction in TRO patients. The failure rate is less than 10% and may be addressed by a second surgery.
authors.affiliation: Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. guybensimon@gmail.com
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Ben Simon
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Mansury
authors.forename: Robert M
authors.initials: RM
authors.lastname: Schwarcz
authors.forename: Sara
authors.initials: S
authors.lastname: Modjtahedi
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D003228:Conjunctiva / Q000601:surgery*; D005141:Eyelid Diseases / Q000209:etiology / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome