Muller-muscle recession for mild to moderate upper-eyelid retraction

Victor B. Lopez, MD, Maria Elizabeth T. Concepcion, MD

To describe a surgical procedure for the relief of mild to moderate uppereyelid retraction secondary to Graves’ ophthalmopathy using a graded, controlled recession of Muller muscle without recession of the levator aponeurosis.

Medical records of patients with mild to moderate upper-eyelid retraction secondary to Graves’ ophthalmopathy who underwent Muller-muscle recession were reviewed. Five female patients 40 to 48 years of age were included. All were biochemically and clinically euthyroid for at least 6 months before the surgery. Patients had neither fibrosis nor exophthalmos. The outcome was evaluated 2 weeks after the operation by measuring the eyelid aperture and corneal light reflex to upper-lid-margin distance (MRD1) in the primary
position. Patients were assessed to have upper-eyelid retraction when the MRD1 is > 4. Corneal staining was assessed. Pre- and postoperative photographs were compared. The outcome was classified as good, acceptable, or unacceptable. The result was deemed stable if measurements remained unchanged during follow-up.

Seven upper eyelids (of 5 patients) were corrected using Muller-muscle recession only. The procedure yielded good results in 2 cases of bilateral uppereyelid retraction (MRD1 4.5 to 8 mm). For three patients who had unilateral upper-eyelid retraction (MRD1 4 to 8 mm), the results were good in 2 cases and acceptable in 1.

Muller-muscle recession is an effective means of relieving mild to moderate upper-eyelid retraction in patients with Graves’ ophthalmopathy before fibrosis sets in.

Keywords: Graves’ ophthalmopathy, Graves’ disease, lid retraction, Muller muscle, Exophthalmos