Outcomes of Various Surgical Procedures on Acquired Lower Eyelid Epiblepharon in Thyroid Associated Ophthalmopathy

PURPOSE: To report the outcomes of acquired lower eyelid epiblepharon after various surgeries in thyroid associated ophthalmopathy (TAO) patients. METHODS: A retrospective review of the medical records of 53 TAO patients with acquired lower eyelid epiblepharon between October 1999 and June 2011 was performed. Data were collected on demographics, type of lower eyelid epiblepharon, the detailed surgical history such as orbital decompression, retraction repair, or epiblepharon repair and surgical outcomes including follow-up period, recurrence of epiblepharon, and post-operative complications. RESULTS: Among the 53 TAO patients with acquired lower eyelid epiblepharon, 25 eyes of 17 patients underwent surgical management; 6 eyes of orbital decompression, 1 eye of orbital decompression followed by retraction repair, 2 eyes of orbital decompression followed by epiblepharon repair, 6 eyes of lower eyelid retraction repair, and 10 eyes of epiblepharon repair. Twenty two lower eyelid epiblepharons (88%) were resolved after final surgical treatment without complication during mean 16.2 months (SD, ±29.9 months) of follow up period; three of 6 epiblepharons that remained after orbital decompression underwent subsequent surgical management of retraction repair or epiblepharon repair, and epiblepharons were well-corrected. Mean amount of lower eyelid retraction was decreased from 1.68 mm (SD, ±1.17 mm) to 0.29 mm (SD, ±0.44 mm) after surgery, regardless of the type of surgery (n = 25, p < 0.000, Wilcoxon signed rank test). CONCLUSIONS: Acquired lower eyelid epiblepharon of TAO should be managed sequentially according to the general serial order of surgical managements in TAO; orbital decompression, correction of lower eyelid retraction and epiblepharon repair. Acquired lower eyelid epiblepharon was well resolved after surgical management in consecutive order, especially after repair of the lower eyelid retraction with a graft, or lower eyelid epiblepharon repair. Decreased lower eyelid retraction with a resolution of epiblepharon after surgery implied that lower eyelid retraction was associated with lower eyelid epiblepharon.