Abstract

SA.25.06

Surgical correction of Lidabnormalities in Graves ophthalmopathy (GO)

Eckstein A., Esser J.
Department of Ophthalmology, University of Essen

Lid surgery represents the last step in the surgical rehabilitation of GO patients. The most common indication is the upper lid retraction due to fibrosis of the levator muscle. True lid retraction has to be differentiated from pseudo-lidretraction due to fibrosis of the inferior rectus muscle. The latter resolves after inferior rectus recession. Lower lid lengthening is indicated in lower lid retraction after inferior rectus recession. Bilateral lower lid retraction with proptosis should be primarily referred for orbital decompression. Result following lower lid lengthening in patients with disfiguring proptosis, who decline orbital decompression is poor. Upper lid retraction can be reduced by injecting 5-15 IU of botulinum toxin subconjunctivally or transcutaneously in the Levator/Mueller muscle to overcome the time until lid surgery is possible or even instead of. Many different techniques have been described to lengthen the upper and the lower lid. Spacers are necessary for lengthen lower lid while lengthen the upper lid is possible without using a spacer. Various materials have been used for spacers. These include among others auricular cartilage, hard palate mucosa, tarsoconjunctival transplant, expanded polyethylene, donor sclera, pericardium. Since lateral retraction (flare) is the most important aspect of upper lid retraction in patients with GO, division of the lateral horn of the aponeurosis is necessary in most cases. In case of tarsorrhaphy the “Elschnig” procedure should be applied due to tension on the lids in case of proptosis. Upper lid debulking and blepharoplasty are the final surgical procedures in the functional and cosmetic rehabilitation of the GO patient. Redundant skin and fat can be excised using scissors and bipolar cautery, laser or monopolar cauterisation needle. Most of the surgical procedures are described with success rates of about 70-90%.

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