Blepharotomy Versus Levator Recession With Adjustable Sutures for Correction of Upper Eyelid Retraction in Thyroid Eye Disease.

PURPOSE: To compare outcome, complications and surgical time of blepharotomy versus levator recession with adjustable sutures (LRWAS) for correction of upper eyelid retraction in thyroid eye disease.

METHODS

In the period 2019-2023, we performed a prospective randomized comparative study between blepharotomy and LRWAS. We examined patients, recorded time consumption, and obtained photographs preoperatively, 1 day, 1 week, 3 months, and 6 months after surgery. Outcome was categorized according to Mourits and Sasim`s classification from 1999 (perfect-acceptable-unacceptable).

RESULTS

A total of 30 patients (25 women) with a median (range) age of 51.5 (34-74) years at surgery were included. A significant different ( p < 0.01) median operation time was found between blepharotomy (41.5 (17-105) minutes) and LRWAS (68 (35-101) minutes). Median time from operation to last examination was 6 (6-18) months. Fifteen patients (24 eyelids) were operated with blepharotomy and 15 patients (25 eyelids) with LRWAS. Preoperative median margin reflex distance 1 was 6.5 (5-8) mm, and at final visit, median margin reflex distance 1 was 3.5 (3-4) mm after blepharotomy and 3.5 (2-5.5) mm after LRWAS. Reoperation was performed in 11 eyelids, 10 due to overcorrection and 1 because of a residual retraction. Significantly more eyelids needed reoperation after LRWAS (n = 9) compared with blepharotomy (n = 2). At final examination, a perfect or acceptable result was found in 14 (93%) patients after both procedures. Significantly shorter total duration of all visits was observed after treatment with blepharotomy (50 (35-70) minutes) compared with LRWAS (65 (40-115) minutes). Wound dehiscence occurred in 1 patient after blepharotomy, and 1 postoperative infection was observed after LRWAS.

CONCLUSION

We demonstrate equally high success rates after blepharotomy and LRWAS for correcting upper eyelid retraction in thyroid eye disease, but blepharotomy is less time-consuming and implies fewer reoperations.