title: Surgical technique: modified lateral tarsorrhaphy.
abstract: OBJECTIVE
  The signs of thyroid eye disease include proptosis, eyelid retraction, and exposure of the ocular surface, resulting in a symptomatic and unsatisfactory aesthetic appearance. A number of surgical techniques have been proposed to treat the eyelid sequelae of thyroid eye disease, which vary in both complexity and potential complications; the authors propose a novel technique for correcting inferolateral scleral show. This technique is proposed for cases of mild inferior scleral show (2 mm or less).
  
  
  METHODS
  This retrospective consecutive case series includes 7 eyes of 5 patients from 2003 to 2006. All patients underwent surgery by a single surgeon at Moorfields Eye Hospital, London, UK. The surgical technique is composed of 3 principal steps: 1) marking of intended lateral tarsorrhaphy, 2) gray line split and anterior lamella excision, and 3) suturing of upper and lower limbs of lateral canthal tendon/lateral ends of tarsal pates) and canthal angle reformation.
  
  
  RESULTS
  Seven eyes of 5 patients underwent the procedure; all patients were women, and their mean age was 49.6 years (range 29-67). Mean inferior scleral show was reduced from 2.0 mm preoperatively (range 1.5-2.5) to 0.3 mm postoperatively (range 0.0-0.5) at 49-month follow up. There were no complications related to the surgical technique, and all patients were satisfied with the postoperative result. One patient with proptosis measuring 24 mm required 2-wall orbital decompression 20 months later.
  
  
  CONCLUSIONS
  Patient selection is important for the effective use of the modified tarsorrhaphy technique and should be reserved for those with 2 mm or less of inferior scleral show. Two principal factors to be considered before this eyelid surgery and the use of a box suture in reformation of the lateral canthal angle are discussed. Although a number of surgical procedures are available to manage eyelid malposition secondary to thyroid eye disease, they vary in complexity and severity of complications. The modified tarsorrhaphy technique was effective in the treatment of a specific group of patients who had undergone previous orbital and eyelid surgery for thyroid eye disease.
authors.affiliation: Adnexal Service, Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Don J
authors.initials: DJ
authors.lastname: de Silva
authors.forename: Yashin D
authors.initials: YD
authors.lastname: Ramkissoon
authors.forename: Andre R
authors.initials: AR
authors.lastname: Ismail
authors.forename: Michèle
authors.initials: M
authors.lastname: Beaconsfield
mesh_terms: D000328:Adult; D000368:Aged; D005141:Eyelid Diseases / Q000209:etiology / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D018579:Patient Selection; D012189:Retrospective Studies; D013536:Suture Techniques