Is this swelling or lid retraction? Three months post orbital decompression. (photos)

I had orbital decompression three months ago after having Graves orbitopathy for about five years. One of my lower eyelids still appears swollen, but my surgeon thought it might be residual eyelid retraction from the TED. It feels to me like there's something in there, but I also worry the muscles are stretched out after five years with 22mm of proptosis. Will this go away or is it a retraction issue?

Doctor Answers 3

Eyelid Retraction in Thyroid Eye Disease

It appears as if there is still some residual eyelid retraction.  It's best to wait at least three months after orbital decompression surgery before proceeding with correction of residual eyelid retraction.  Therapy for thyroid eye disease is a process and must be custom-tailored to best address each individual patient's specific concerns and issues.


Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 9 reviews

Eyelid retraction from graves thyroid eye disease

It is likely eyelid retraction as swelling doesn't persist this long after surgery but best to see an oculoplastic surgeon for evaluation. See following link too.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 61 reviews

These are very complex situations.

The photos don't suggest that you have swelling but it is possible to have some degree of persistent swelling even 3 months after an orbital decompression surgery.  It is very hard to make the position of the two eyes perfectly symmetric. In the photos, there is still trace left upper eyelid retraction.  The position of the right upper eyelid looks good.  The lower eyelids are a bit low.  The principle reason for repositioning the lower eyelids would be to manage dry eye.  You would also get some aesthetic benefit. Some might advocate additional orbital decompression here but recognize there will always be differences in opinion regarding how best to manage your overall rehabilitation. Generally it is helpful to have inferior orbital rim augmentation in these cases.  Some surgeons try to avoid using a spacer graft in these lower eyelid.  Having done over a thousand lower eyelid reconstructions, I think this micro trend is corner cutting for busy surgeons and not helpful for eyelids and their owners.  I think these reconstructions do very much benefit from a lower eyelid spacer graft.  Note the video attached takes about lower eyelid retraction after blepharoplasty but the approach is the same for fixing lower eyelid retraction after orbital decompression.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

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