Surgical options for correction of eyelid retraction in thyroid eye disease

Upper eyelid retraction is the most common ophthalmic feature of thyroid eye disease. Next to increasing ocular discomfort, foreign body sensation, photophobia, epiphora, alteration in appearance and disfigurement, serious visionthreatening corneal decompensation may occur. Conservative treatment of eyelid retraction is usually insufficient. In most cases surgical intervention is needed to lengthen the affected eyelid and produce a functional eyelid that protects the globe and vision. Procedures should address the anatomical and pathophysiological causes of eyelid retraction, which may affect all layers of the eyelid in varying degrees. The surgical treatment of eyelid retraction is therefore a very challenging procedure, with sometimes unpredictable results. Surgery should always be tailored to the patient’s specific anatomical and functional needs and best results may be expected through the least invasive approach.