The results of surgical treatment to correct eyelid retraction with blepharotomy – preliminary report Original research study

Main Article Content

Radosław Różycki
Katarzyna Ulaszewska
Katarzyna Różycka
Alan Chamernik
Małgorzata Różycka
Piotr Nesterowicz


The study presents early results of the surgical treatment of patients with fixed upper eyelid retraction exceeding 1 mm as a complication of Graves’ disease, trauma, or high myopia.

10 patients (8 women and 2 men), with an average age of 45, participated in the study. A total of 17 upper eyelids were operated on using the full-thickness blepharotomy method. According to the EUGOGO scale for the surgery 2 patients had mild retraction, 7 – moderate retraction, and 1 – severe retraction. The procedures were performed under local anesthesia, following current knowledge and described operative techniques.

Each operated patient achieved both aesthetic and functional improvement compared to the baseline. The results were evaluated based on the reduction of the upper eyelid relative to the corneal limbus, reaching a level covering the corneal limbus. The average satisfaction score obtained was 8 points in 0–10-point scale.

Blepharotomy is an effective therapeutic procedure for upper eyelid retraction, reducing eye exposure symptoms and restoring a normal appearance of the eyelids. The procedure has rare serious side effects, and patients are content with the results.


Download data is not yet available.

Article Details

How to Cite
Różycki R, Ulaszewska K, Różycka K, Chamernik A, Różycka M, Nesterowicz P. The results of surgical treatment to correct eyelid retraction with blepharotomy – preliminary report. Ophthatherapy [Internet]. 2024Mar.31 [cited 2024Jul.17];11(1):77-3. Available from:
Surgery and laser therapy


1. Lazarus JH. Epidemiology of Graves’ orbitopathy (GO) and relationship with thyroid disease. Best Pract Res Clin Endocrinol Metab. 2012; 26(3): 273-9.
2. Nimitwongsakul A, Zoumalan CI, Kazim M. Modified full-thickness blepharotomy for treatment of thyroid eye disease. Ophthalmic Plast Reconstr Surg. 2013; 29(1): 44-7.
3. Garcia DM, Messias A, Costa LO et al. Spontaneous blinking in patients with Graves’ upper eyelid retraction. Curr Eye Res. 2010; 35(6): 459-65.
4. Dutton JJ. Anatomic Considerations in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg. 2018; 34(4S Suppl 1): S7-12.
5. Bartalena L, Kahaly GJ, Baldeschi L et al. The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy. Eur J Endocrinol. 2021; 185(4): G43-67.
6. Marcocci C, Altea MA, Leo M. Treatment options for Graves’ orbitopathy. Expert Opin Pharmacother. 2012; 13(6): 795-806.
7. Osaki TH, Monteiro LG, Osaki MH. Management of eyelid retraction related to thyroid eye disease. Taiwan J Ophthalmol. 2022; 12(1): 12.
8. Higuchi T, Satoh T, Yokozeki H et al. Palpebral edema as a cutaneous manifestation of hyperthyroidism. J Am Acad Dermatol. 2003; 48(4): 617-9.
9. Shih MJ, Liao SL, Kuo KT et al. Molecular pathology of Muller’s muscle in Graves’ ophthalmopathy. J Clin Endocrinol Metab. 2006; 91(3): 1159-67.
10. Davies MJ, Dolman PJ. Levator Muscle Enlargement in Thyroid Eye Disease-Related Upper Eyelid Retraction. Ophthalmic Plast Reconstr Surg. 2017; 33(1): 35-9.
11. Harrison AR, McLoon LK. Effect of hyperthyroidism on the orbicularis oculi muscle in rabbits. Ophthalmic Plast Reconstr Surg. 2002; 18(4): 289-94.
12. Collin JR, Allen L, Castronuovo S. Congenital eyelid retraction. Br J Ophthalmol. 1990; 74(9): 542-4.
13. Kansu T, Subutay N. Lid retraction in myasthenia gravis. J Clin Neuroophthalmol. 1987; 7(3): 145-50.
14. Bartley GB. The differential diagnosis and classification of eyelid retraction. Ophthalmology. 1996; 103(1): 168-76.
15. Collin JRO. A Manual of Systematic Eyelid Surgery 3rd Edition. Butterworth-Heinemann, 2006.
16. Ben Simon GJ, Mansury AM, Schwarcz RM et al. Simultaneous orbital decompression and correction of upper eyelid retraction versus staged procedures in thyroid-related orbitopathy. Ophthalmology. 2005; 112(5): 923-32.
17. Henderson JW. A surgical procedure for retraction of eyelids in endocrine exophthalmos (a moving picture). Trans Am Ophthalmol Soc. 1965; 63: 70-4.
18. Putterman AM, Urist M. Surgical treatment of upper eyelid retraction. Arch Ophthalmol. 1972; 87(4): 401-5.
19. Ben Simon GJ, Mansury AM, Schwarcz RM et al. Transconjunctival Müller muscle recession with levator disinsertion for correction of eyelid retraction associated with thyroid-related orbitopathy. Am J Ophthalmol. 2005; 140(1): 94-9.
20. Hintschich C, Haritoglou C. Full thickness eyelid transsection (blepharotomy) for upper eyelid lengthening in lid retraction associated with Graves’ disease. Br J Ophthalmol. 2005; 89(4): 413-6.
21. Guastella C, di Furia D, Torretta S et al. Upper Eyelid Retraction in Graves’ Ophthalmopathy: Our Surgical Experience on 153 Cases of Full-Thickness Anterior Blepharotomy with Mullerectomy. Aesthetic Plast Surg. 2022; 46(4): 1713-21.
22. Lee J, Lee H, Park M et al. Modified Full Thickness Graded Blepharotomy for Upper Eyelid Retraction Associated With Thyroid Eye Disease in East Asians. Ann Plast Surg. 2016; 77(6): 592-6.
23. Elner VM, Hassan AS, Frueh BR. Graded full-thickness anterior blepharotomy for upper eyelid retraction. Arch Ophthalmol. 2004; 122(1): 55-60.
24. Aveta A, Tenna S, Segreto F et al. Acute lymphedema of the eyelid after major reconstruction of the medial canthus: the role of the lymphatic drainage pattern. Plast Reconstr Surg. 2011; 128(4): 370e-2e.
25. Cruz AAV, Ribeiro SFT, Garcia DM et al. Graves upper eyelid retraction. Surv Ophthalmol. 2013; 58(1): 63-76.