title: Stability of eyelid height after graded anterior-approach lid lowering for dysthyroid upper lid retraction.
abstract: OBJECTIVE
  To investigate the outcome of a modified anterior approach surgical procedure for the correction of primary upper eyelid retraction in thyroid eye disease.
  
  
  METHODS
  A retrospective review of 52 consecutive cases (in 32 patients) of anterior-approach graded upper lid lowering for the treatment of primary eyelid retraction, carried out at Moorfields Eye Hospital between 2006-2009 was conducted. Measurements of upper margin-reflex distance (MRD), upper lid skin crease height and skin fold height were taken from clinical records and photographs. A comparison between pre-operative and both early and late post-operative measurements was conducted, with a maximal follow-up of 12 months. Surgery was considered successful when all of the following criteria were met; an upper lid margin covering 0.5-1.5 mm of the superior cornea in the 12 o'clock position, smooth eyelid contour, skin crease height within 6-10 mm or upper lid skin fold within 2-5 mm of the lid margin, symmetry of lid position (difference in MRD of < 1 mm between both eyes) and patient satisfaction.
  
  
  RESULTS
  A successful outcome was achieved in 86.5% (45/52) of lids with a single procedure. For the whole group, the mean MRD was 7.0 mm pre-operatively and 3.6 mm at 1 month after surgery. The corresponding values from photographic estimates were 6.5 mm and 3.6 mm, respectively. These values remained stable over the maximum follow-up period of 12 months. Under-correction occurred in 6/52 (11.5%) lids, one of which had persistent lateral flare, whereas over-correction occurred in 1/52 (2%).
  
  
  CONCLUSIONS
  The described surgical approach produces reasonably predictable and stable outcome for upper eyelid lowering in patients with thyroid eye disease.
authors: Moorfields Eye Hospital, London, England.
authors: Alex J
authors: AJ
authors: Shortt
authors: Maninder
authors: M
authors: Bhogal
authors: Geoffrey E
authors: GE
authors: Rose
authors: Sabrina
authors: S
authors: Shah-Desai
mesh_terms: D000328:Adult; D000368:Aged; D005141:Eyelid Diseases / Q000601:surgery; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D010781:Photography; D012189:Retrospective Studies; D016896:Treatment Outcome