Graves upper eyelid retraction.

Graves upper eyelid retraction (GUER) is the most common and characteristic sign of Graves orbitopathy. Despite being well recognized since the 19th century, GUER is still a subject of controversy. We review GUER, including historical aspects, diagnosis, methods of measurements, ocular surface abnormalities, etiology, and medical and surgical treatments. There is no consensus about the mechanisms of its etiology or the best surgical correction. There is a need for quantitative studies on the effects of GUER on lid movements.

Pre- and postoperative quantitative analysis of contour abnormalities in Graves upper eyelid retraction.

PURPOSE: One of the most common problems of the surgical management of Graves upper eyelid retraction is the occurrence of eyelid contour abnormalities. In the present study, the postoperative contour of a large sample of eyelids of patients with Graves orbitopathy was measured. METHODS: The postoperative upper eyelid contour of 62 eyes of 43 patients with Graves orbitopathy was subjectively classified by 3 experienced surgeons in 3 categories: poor, fair, and good. The shape of the eyelid contours in each category was then measured with a recently developed custom-made software by measuring multiple midpupil eyelid distances each 15° along the palpebral fissure. The upper eyelid contour of 60 normal subjects was also quantified as a control group. RESULTS: The mean ratio between the sum of the lateral and medial midpupil eyelid distances (lateral/medial ratio) was 1.10 ± 0.11 standard deviation in controls and 1.15 ± 0.13 standard deviation in patients. Postoperatively, the mean midpupil eyelid distance at 90° was 4.16 ± 1.13 mm standard deviation. The distribution lateral/medial ratios of the eyelids judged as having good contours was similar to the distribution of the controls with a modal value centered on the interval between 1.0 and 1.10. The distribution of lateral/medial ratios of the eyelids judged as having poor contour was bimodal, with eyelids with low and high lateral/medial ratios. Low lateral/medial ratios occurred when there was a lateral overcorrection, giving the eyelid a flat or a medial ptosis appearance. High lateral/medial ratios were due to a central or medial overcorrection or a lateral peak maintenance. CONCLUSIONS: Postoperative upper eyelid contour abnormalities can be quantified by comparing the sum of multiple midpupil eyelid distances of the lateral and medial sectors of the eyelid. Low and high lateral/medial ratios are anomalous and judged as unpleasant.

Oculomotor disturbances due to granular cell tumor.

Primary granular cell tumor of the orbit is a rare type of neoplasm. The tumor is frequently associated with extraocular muscles, and eye motility limitation is an unavoidable complication after its surgical removal. The objective of the present article is to review the literature on primary granular cell tumors of the orbit and to report a case of this uncommon neoplasia. Granular cell tumor is a benign lesion encountered in most cases (58.3%) in the inferior aspect of the orbit. Extraocular muscle involvement occurs in 72.2% of the patients, and diplopia is present in 77.1% of the cases. The inferior and medial recti are the most affected muscles (38.5% and 26.9%, respectively). Surgical excision is the only modality of treatment, but diplopia persists in 73.3% of the cases. In conclusion, granular cell tumor is a benign lesion but involves a high rate of extraocular muscle morbidity.