Takahira Tokuei, Akita Shinsuke, Maei Haruka, Kubota Yoshitaka, Mitsukawa Nobuyuki
Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Plast Reconstr Surg Glob Open. 2021 Jul 21;9(7):e3706. doi: 10.1097/GOX.0000000000003706. eCollection 2021 Jul.
Blepharoplasty for thyroid eye disease (TED) has been indicated for the purpose of improving upper and lower eyelid retraction caused by exophthalmos. Both aponeurotic blepharoptosis and aging lower eyelid are common conditions that require plastic surgeries and could be complicated with other disease conditions, such as TED. This is the first report of planned and staged treatment of the contradictory pathophysiologies of aging changes of upper and lower eyelids associated with TED. A 59-year-old woman suffered complicated bilateral asymmetric aponeurosis blepharoptosis of the lower and upper eyelids, caused by both advanced aging and TED. To achieve aesthetic improvement, three-stage surgical treatments were planned, as follows: (1) Orbital decompression for exophthalmos; (2) Extraocular muscle surgery, if necessary; (3) Blepharoplasty for functional and aesthetic abnormalities due to loosening of the upper and lower eyelids. After medial and lateral orbital floors were opened bilaterally, the patient did not need extraocular surgery. As the final step, levator aponeurosis advancement procedure was performed in the upper eyelids for bilateral asymmetrical aponeurotic blepharoptosis, and transitional lower blepharoplasty using a skin-muscle flap technique via a sub-ciliary incision was performed in the lower eyelids for age-related loosening. The typical face displayed by Graves' disease disappeared, and the symptoms associated with loosening of the upper and lower eyelids improved substantially. Improvement of exophthalmos by orbital decompression revealed the severity of the blepharoptosis and the aging change of lower eyelid. Step-by-step planning from decompression surgery to upper and lower blepharoplasty could lead to sufficient improvement in the facial appearance in TED.
甲状腺眼病（TED）的眼睑成形术旨在改善眼球突出引起的上睑和下睑退缩。腱膜性上睑下垂和老年性下睑松弛都是常见的需要整形手术的情况，并且可能与其他疾病状况（如TED）并发。这是第一份关于与TED相关的上睑和下睑衰老变化的矛盾病理生理学的计划性和分阶段治疗的报告。一名59岁女性因衰老和TED导致双侧上下眼睑复杂的不对称腱膜性上睑下垂。为了实现美学改善，计划进行三阶段手术治疗，如下：（1）眼球突出的眼眶减压；（2）必要时进行眼外肌手术；（3）针对上下眼睑松弛导致的功能和美学异常进行眼睑成形术。双侧打开眶内侧和外侧壁后，患者不需要眼外肌手术。作为最后一步，对上睑进行提上睑肌腱膜推进术以治疗双侧不对称腱膜性上睑下垂，对下睑采用经睫下切口的皮肤肌肉瓣技术进行过渡性下睑成形术以治疗与年龄相关的松弛。Graves病典型的面容消失，上下眼睑松弛相关症状明显改善。眼眶减压改善眼球突出后，显示出上睑下垂的严重程度和下睑的衰老变化。从减压手术到上下睑成形术的逐步规划可使TED患者的面部外观得到充分改善。
