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UPPER LID RETRACTION IN THYROID EYE DISEASE

UPPER LID RETRACTION IN THYROID EYE DISEASE (02/08)

This causes an abnormal appearance, irritation and watering. The increased exposed surface area of the globe and the decreased blink function from the retraction each make things worse.

The precise cause(s) is/are quite complex and retraction may be due to several different factors:

1. Stimulation of Muller's muscle, a sympathetic muscle in the upper lid.
2. Proptosis itself.
3. A stiff inferior rectus muscle.

Any other surface problem will make symptoms worse [blepharitis, dry eye, conjunctival irregularity such as pingueculum, etc.].

TREATMENTS

Wearing sunglasses [especially large wrap around ones] will decrease tear film evaporation and help symptoms (and provide camouflage).

Lubricant eye drops will compensate for some of the problems - try lots of different ones to find the one[s] that suits you best.

If mechanism [1] is relevant, we can import some [expensive] guanethidine eye drops for you to try. They sometimes work well. If mechanism (3) is the most important, eye muscle surgery may be eventually required.

If lid retraction persists and is troublesome (either cosmetically or because it causes persistent irritation) various eyelid surgeries help. Botox injections to the upper lid helps some patients.



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