title: Graded full-thickness anterior blepharotomy for correction of upper eyelid retraction not associated with thyroid eye disease.
abstract: OBJECTIVE
  To evaluate the efficacy of graded full-thickness anterior blepharotomy for upper eyelid retraction of various causes not associated with Graves eye disease.
  
  
  METHODS
  Twenty-one eyelids of 18 patients with upper eyelid retraction not caused by Graves eye disease were treated with graded full-thickness anterior blepharotomy. Preoperative and postoperative symptoms, midpupil to upper eyelid distance, lagophthalmos, and superficial punctuate keratopathy were evaluated.
  
  
  RESULTS
  Upper eyelid retraction was due to facial nerve palsy in 4 patients (22%), overcorrected ptosis in 5 patients (28%), and cicatrix after trauma in 6 patients (33%). One patient each (6% each) had retraction from graft-versus-host disease, after blepharoplasty, and after orbicularis oculi myectomy for blepharospasm. At a mean of 10 months follow-up, presenting symptoms resolved or improved in 17 patients (94%) and remained unchanged in 1 patient (6%). Midpupil to upper eyelid distance, lagophthalmos, and superficial punctuate keratopathy all improved significantly (all p < 0.001). No surgical complications occurred.
  
  
  CONCLUSIONS
  Graded full-thickness anterior blepharotomy is a safe, effective, and rapid technique for patients with symptomatic upper eyelid retraction due to etiologies other than Graves eye disease. This technique improves symptoms and signs of ocular exposure while addressing relative upper eyelid height symmetry and contour.
authors.affiliation: Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Hakan
authors.initials: H
authors.lastname: Demirci
authors.forename: Adam S
authors.initials: AS
authors.lastname: Hassan
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Reck
authors.forename: Bartley R
authors.initials: BR
authors.lastname: Frueh
authors.forename: Victor M
authors.initials: VM
authors.lastname: Elner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D005141:Eyelid Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005143:Eyelids / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006111:Graves Disease / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged