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Trans Am Ophthalmol Soc. 2003;101:67-73; discussion 73-5.

Graded full-thickness anterior blepharotomy for upper eyelid retraction.

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Department of Ophthalmology, University of Michigan, Ann Arbor, USA.



A chief morbidity of Graves' eye disease (GED) is upper lid retraction that results in exposure keratopathy and cosmetic deformity. This study was conducted to assess the efficacy of graded anterior blepharotomy to treat upper lid retraction.


Fifty eyelids of 32 patients with GED-associated upper lid retraction causing symptomatic ocular exposure were treated with graded, transcutaneous, full-thickness, anterior blepharotomy. Preoperative and postoperative ocular exposure symptoms, upper lid position, lagophthalmos, and keratopathy were compared.


At an average of 8.5 +/- 8.1 months (range, 2 to 35 months) follow-up, more than 90% of preoperative symptoms resolved or improved. Upper eyelid position (P < .00001), lagophthalmos (P < .0001), and keratopathy (P < .01) were significantly improved. Mild contour abnormalities (all < or = 1 mm) occurred in 7 of 50 eyelids. Eyelid crease recession or asymmetry occurred in 4 of 22 patients with postoperative lid crease measurements. Complications of ptosis, wound dehiscence, and full-thickness hole each occurred once. The average time for performing the procedure was 31.5 +/- 8.9 minutes per eyelid.


Graded anterior blepharotomy for upper lid retraction is a safe and highly effective surgical treatment for symptomatic GED-associated upper eyelid retraction. This technique achieves excellent functional and cosmetic outcomes.

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