Levator and Müller muscle retraction

The upper eyelid retracted, showing a widening of the eye crack and partial exposure of the upper sclera. When the eyeball is looking down, the upper jaw cannot move down with the eyeball and moves downward, showing hysteresis. It is one of the most common eye diseases of Graves' eye disease, accompanied by hyperthyroidism, mostly in the incidence of both eyes, and normal thyroid function is mostly monocular. Curing disease: Indication 1, Müller muscle resection combined with the removal of the diaphragmatic aponeurosis after the detachment of the sacral part is still not enough to correct the retraction of the upper iliac crest. 2, severe Müller muscle and lifting the diaphragmatic fibrosis and shortened. Surgical procedure 1. Flip the upper jaw with the eye hook and the traction stitch. In the lateral condylar conjunctiva, the vertical incision margin was 5 mm long, and the Müller muscle was bluntly separated from the conjunctiva, and a rubber strip was placed between the two. 2, open the skin at the upper fold, separate the anterior orbital aponeurosis of the tarsal plate, expose the tarsal plate and lift the aponeurosis of the diaphragm, and separate upwards in front of the aponeurosis. 3, at the edge of the tarsal plate (the iliac artery arch in front of the Müller muscle, above the sacral edge, do not damage), cut the aponeurosis of the diaphragm and Müller muscle to expose the rubber strip, and extract it. Make 3 pairs of temporary suture stitches above the broken end with a 5-0 silk thread to completely break the aponeurosis and Müller. 4, the amount of eyelid retraction measured before surgery (such as the disease side splitting is 3mm higher than the healthy side, the retraction amount is 3mm) plus 4mm as the height of the scleral lens, with 9-0 nylon thread for 3 pairs of suture stitching, will The preserved sclera is sutured on the aponeurosis and Müller muscle complex. The temporary suture was removed, and the scleral lens and the sacral edge were sutured with a 9-0 nylon thread. 5, eyelid rim muscle and skin together with 5-0 silk sutures.