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Purpose : To report the change of eyelid contour by measuring mid-pupil lid distance (MPLD) on Graves’ ophthalmopathy (GO) patients who underwent orbital decompression.
Methods : During August 2016 to March 2017, patients with GO who received orbital decompression were enrolled. All patient’s demographic and surgical data were obtained. Facial photos were taken within 2 months preoperatively and at 3 months postoperatively. Software-assisted calculations of MPLD at different directions (15 degrees apart) were done. To compare pre-operative and post-operative data, paired t test was used. Pearson correlation test was performed to examine the correlation between changes of MPLD, Hertel reading, and fat removal amount.
Results : 24 patients (46 eyes) were included, including 7 patients (14 eyes) with bony decompression and 17 patients (32 eyes) with fat decompression. Preoperative Hertel reading correlates significantly with upper MPLDs (r = 0.64, p < 0.001) but not lower MPLDs. After orbital decompression, lower MPLDs showed a significant decrease (Δ = -0.55 mm, p = 0.017) in both bony and fat decompression groups. Upper MPLDs showed different tendencies in either group (bony: -0.68 mm; fat: +0.39 mm) although not achieving significance. The change of lower MPLDs failed to reveal correlation with the reduction of proptosis (r = 0.071, p = 0.697). Subgroup analysis showed a significant correlation between upper MPLDs and Hertel reading changes after bony decompression (r = 0.683, p = 0.007). No significant change of eyelid contour symmetry by calculating nasal-temporal MPLD ratio postoperatively.
Conclusion : Orbital decompression produces a positive therapeutic effect on lower eyelid retraction. Our study showed that the effect is not correlated with the amount of proptosis reduction. Upper eyelid position can also be affected by orbital decompression, but the effect is more unpredictable. Limited effect was put on eyelid contour by orbital decompression when comparing the nasal-temporal symmetry.
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