Eyelid Retraction Surgery for Thyroid Eye Disease

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Thyroid eye disease (TED) often leads to noticeable changes to your eyes and face. Not only are the eyes affected, but the eyelids and the tissues around the eye can also be targeted and damaged by TED. Retracted (pulled back) eyelids can result from the swelling and tightening of the muscles around the eye.1

While it is true that retracted eyelids can change the appearance of the eyes and face, these problems are not just cosmetic.

TED can attack the muscles of the eyelids, making them swollen and stiff. Eventually, the hardened muscles lose normal function. This loss of function causes the eyelids to pull back, making it hard or even impossible to blink or close your eyes.2

If you cannot fully close your eyes, the surface of your eyes become dry and irritated. Dry eye symptoms worsen when the eyes bulge or protrude forward in the eye socket, also a common symptom of TED.2

What is eyelid repair?

If your eyelids are pulled back, it is hard or impossible to blink or close your eyes. Also, your eyelids might open too wide and make it look like you are always staring.

Eyelid repair surgery may be needed to release the tight tissues and muscles around the eyelid. Surgical repair allows your eyelids to return to their natural shape and position. This not only helps with the cosmetic appearance of your face but also the function of your eyelids.1,3

Eyelid repair is performed after the inflammatory active phase of TED, when swelling and damage is reduced.3

Types of eyelid repair

Depending on your symptoms and level of damage from TED, repairs include:

Upper eyelid

In this surgery, the upper eyelid muscles are surgically loosened, and hardened tissue is released. This repair usually involves numbing shots with only a small amount of IV sedation or relaxation.4

Lower eyelid

With lower lid repair, the scarred muscle is surgically loosened. For moderate to severe lower eyelid retraction, tissue may be inserted. This tissue helps to push the eyelid upward to a more natural position.4

What are the possible side effects of eyelid repair surgery?

Along with minor pain, bruising, and discomfort after the repair, some side effects are possible. These include:5,6

  • Vision problems Blurred or double vision are usually mild and last only a few days after surgery.
  • Problems closing your eyes – Some people have problems with closing their eyes after surgery. This is usually temporary but sometimes requires more treatment or another surgery.
  • Swelling and misalignment of the eyelid – Swelling and slight misalignment of the eyelid is not uncommon. This usually goes away with the healing process.
  • Sagging of the lower eyelid – Known as ectropion (ek-troh-pee-in), rolling or sagging of the lower eyelid might occur after eyelid repair.

These are not all the possible side effects of eyelid repair. Talk to your doctor about what to expect with eyelid repair. You also should call your doctor if you have any changes that concern you after the procedure.

Things to know about eyelid retraction surgery

Eyelid retraction surgery occurs in the inactive phase of TED. However, it may be hard to know if you are moving from the active phase to the inactive phase. To help track the severity of your symptoms, take selfie photos in natural light often. Tracking your symptoms in a journal can also help show your TED specialist changes in symptoms over time.2,3

Eyelid repair is performed after decompression surgery and eye muscle surgery, if those are needed.3

Eyelid repair that is needed from the effects of TED is usually covered under medical insurance. Cosmetic repair of mild retraction may not be covered. Be sure to talk to your doctor and insurance when looking at treatment options.

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