lutazene2

Typically, a balanced orbital decompression is performed, which involves removal of the lateral orbital wall (outside wall) and medial orbital wall (inside wall), along with orbital fat. An orbital surgeon removes the lateral wall through a superior eyelid crease incision, and an otolarygologist removes the medial wall by an endoscopic approach through the nose. Usually, both procedures are during the same surgery. This is a major operation requiring general anesthesia and usually an overnight hospital stay. The goal of surgical therapy is not to eliminate double vision entirely, but, rather, to move the region of single binocular vision into a more functional area (straight ahead and down). Because of the unpredictable nature of restricted extraocular muscles, surgery is usually performed with adjustable sutures. Adjustable sutures allow the alignment of the eyes to be fine-tuned in the postoperative period -- when the patient is awake and alert, thus improving the final surgical outcome.Upper lid retraction can cause dry-eye symptoms and corneal exposure, and may even induce a corneal ulcer due to inadequate lid closure. It also contributes significantly to cosmetic disfigurement. Due to the tendency for spontaneous improvement, surgery for isolated upper lid retraction is usually performed only after at least one year of observation. Eyelid retraction surgery is performed after decompressive and strabismus surgeries have been completed and the lid position has been stable for six months or more. Upper lid retraction is corrected with a levator recession operation. The levator muscle (muscle that lifts the eyelid) is lengthened, thus allowing the upper lid to cover more of the eye. One can think of this operation as the opposite of a ptosis (drooping eyelid) repair. Lower eyelid retraction is a common problem in TAO' patients. Patients with lower eyelid retraction complain of tearing, dryness, and foreign-body sensation. They frequently have evidence of exposure keratopathy. The most commonly used method of elevating the lid involves placing a tissue spacer within the back surface of the eyelid, thus effectively elongating the lower lid.



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