Graves lower eyelid retraction (GLLR) is a common and controversial sign of Graves orbitopathy. The authors reviewed the mechanisms and surgical techniques currently used to correct this Graves orbitopathy-related eyelid malposition.
A literature search was performed on the MEDLINE database using the keywords “lower eyelid retraction,” “Graves orbitopathy,” “thyroid ophthalmopathy,” “thyroid eye disease,” “spacers,” and “eyelid surgery.” Only articles in English were included. The level of evidence of publications regarding surgical correction of GLLR was evaluated and graded from I to IV, using a rating system adapted from a validated scientific evidence classification method.
The mechanisms responsible for GLLR are not fully understood and no subtypes of GLLR have been distinguished. The surgical literature of GLLR encompasses mainly descriptions of surgical techniques without objective measurements of the results, and uncontrolled studies. Only 1 randomized controlled trial was identified. To lengthen the lower retractors, a large variety of different materials have been used as spacers.
The scientific literature on GLLR is vast, however controlled and randomized studies comparing different surgical techniques are lacking. At the present moment it is not clear if bioengineered materials are superior to conventional autogeneous tissue as lower eyelid spacers. The effects of GLLR on lower eyelid movements and contour have not been studied.
Although lower eyelid retraction is a common finding in Graves orbitopathy, there is no consensus about its etiology or even the best procedure to alleviate this particular form of eyelid malposition.
*Department of Ophthalmology, Hospital Lusíadas Porto, Porto, Portugal; †Department of Ophthalmology, Hospital de Braga, School of Health Sciences, University of Minho, Braga, Portugal; ‡School of Medicine of Porto, University of Porto, Porto, Portugal; and §Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas-Campus, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Accepted for publication November 2, 2015.
The authors have no financial or conflicts of interest to disclose.
Address correspondence and reprint requests to Antonio Augusto Velasco Cruz, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas-Campus, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo, Brazil. E-mail: firstname.lastname@example.org