title: Lateral and medial upper eyelid contour abnormalities in graves orbitopathy:  the influence of the degree of retraction.
abstract: OBJECTIVE
  To determine the location of contour abnormalities in Graves upper eyelid retraction.
  
  
  METHODS
  Multiple midpupil angular eyelid distances of 75 upper eyelids of 55 patients (mean age = 41.7 ± 13.3 SD years) in the inactive phase of Graves orbitopathy were measured with a recently developed custom-made software. Sixty eyelids of 60 normal subjects were also measured as a control group. A contour peak was defined by the highest midpupil angular eyelid distance normalized (divided) by the superior limit of normality (mean + 2SD).
  
  
  RESULTS
  In 45 eyelids (60%), the peaks were lateral between 120° and 150°. For high levels of retraction, the peaks tended to be centrally located with a substantial number of medial deformities (30 eyelids). Although the lateral and medial peaks were not affected by exophthalmometry, there was a statistically significant increase of medial peaks when midpupil eyelid distance was greater than 6.75 mm (χ = 5.20, p = 0.02).
  
  
  CONCLUSIONS
  Lateral contour abnormalities are more frequent than medial deformities. With minor degrees of retraction, there is a predominance of lateral peaks. With higher degrees of retraction, the number of medial abnormalities is similar to the lateral ones.
authors.affiliation: Department of Ophthalmology, Centro Hospitalar de São João EPE, School of Medicine of Porto, University of Porto, Porto, Portugal.
authors.forename: Sara Filipa Teixeira
authors.initials: SF
authors.lastname: Ribeiro
authors.forename: Gherusa Helena
authors.initials: GH
authors.lastname: Milbratz
authors.forename: Denny Marcos
authors.initials: DM
authors.lastname: Garcia
authors.forename: Vitor Leal
authors.initials: VL
authors.lastname: Fernandes
authors.forename: Amândio
authors.initials: A
authors.lastname: Rocha-Sousa
authors.forename: Fernando Manuel
authors.initials: FM
authors.lastname: Falcão-Reis
authors.forename: Antonio Augusto Velasco
authors.initials: AA
authors.lastname: Cruz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003941:Diagnostic Techniques, Ophthalmological; D005141:Eyelid Diseases / Q000175:diagnosis*; D005143:Eyelids / Q000473:pathology*; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000473:pathology; D009916:Orbital Diseases / Q000175:diagnosis*; D055815:Young Adult