Upper eyelid retraction in Graves' ophthalmopathy: a new surgical technique and a study of the abnormal levator muscle.

A new surgical procedure, the proximal levator technique, achieves recession of the retracted upper eyelid in Graves' ophthalmopathy by sectioning the levator muscle proximal to Whitnall's ligament and fixing eyelid position with sutures that permit postoperative adjustment. This technique deserves further study. Enlargement of the proximal levator muscle in Graves' eye disease is shown on orbital CT scans and is found at surgery when the proximal levator technique is employed. Histologic and morphometric studies demonstrate increased levator muscle fiber size as well as increased extracellular volume. These findings suggest that levator muscle hypertrophy is important in the pathogenesis of upper eyelid retraction in Graves' ophthalmopathy.