Surgical treatment of thyroid-related upper eyelid retraction. Graded Müller's muscle excision and levator recession.

A graded, controlled excision of Müller's muscle with or without recession of the levator aponeurosis using sensory without motor anesthesia is an excellent technique for releasing thyroid-related upper eyelid retraction. The procedure has provided statistically significant success rates in the first 53 upper eyelids treated by this technique that were carefully analyzed postoperatively. It has continued to provide consistently good results in an additional 49 upper eyelids. The six complications in the first 53 cases included nasal ptosis (4), diffuse ptosis (1), and residual eyelid retraction (1). These were easily rectified with a second simple surgical procedure. The operation described is considered superior to other techniques in treating thyroid-related upper eyelid retraction because other procedures have not been analyzed in large enough numbers to demonstrate as high a degree of success as this operation. The procedure is simple, based on anatomic and physiologic principles, tailored to the individual patient intraoperatively, and yields consistently good results.