Analysis of Lid Contour in Thyroid Eye Disease With Upper and Lower Eyelid Retraction Using Multiple Radial Midpupil Lid Distances

Abstract

Purpose:The aim of this study was to analyze upper and lower eyelid contours in adult patients with thyroid eye disease (TED) and normal adults using a software program that measures multiple radial midpupil lid distance (MPLD).Methods:Analysis targeted 61 eyes from 61 normal adults who had never undergone eyelid surgery or ophthalmic surgery and 63 eyes from 63 patients with TED. Digital pictures of primary gaze were analyzed using custom software. Conventional MPLD (90 degrees, 270 degrees) and 12 oblique MPLDs were collected every 15 degrees across the temporal (105 degrees, 120 degrees, 135 degrees, 150 degrees, 165 degrees, 180 degrees) and nasal (75 degrees, 60 degrees, 45 degrees, 30 degrees, 15 degrees, 0 degrees) sectors of the upper eyelid. For lower eyelid contours, 9 oblique MLPDs in the temporal sector (255 degrees, 240 degrees, 225 degrees, 210 degrees, 195 degrees) and nasal sector (285 degrees, 300 degrees, 315 degrees, 330 degrees) of the lower eyelid were analyzed.Results:From all angles, the MPLD of patients with TED was larger than that of the control group. The mean difference between the 2 groups was larger for the upper eyelid (0 degrees approximate to 180 degrees) than the lower eyelid (195 degrees approximate to 330 degrees). When comparing symmetry by dividing into each angle, the ratio of 90 degrees/270 degrees (MRD1/MRD2) demonstrated greater in patients with TED (P=0.000). Temporal/nasal eyelid contour symmetry in the upper eyelid, investigated using the distance ratio of the nasal sector/temporal sector (15 degrees/165 degrees, 30 degrees/150 degrees, 45 degrees/135 degrees, 60 degrees/120 degrees, 75 degrees/105 degrees), was significantly smaller in patients with TED (P<0.05). However, there was no significant difference between the 2 groups regarding temporal/nasal eyelid contour symmetry of the lower eyelid (330 degrees/210 degrees, 315 degrees/225 degrees, 300 degrees/240 degrees, 285 degrees/255 degrees).Conclusions:Radial MPLD is effective for analyzing eyelid contour. In our study, lateral flare of upper lid retraction and flat appearance of lower lid retraction were distinct characteristics in patients with TED. Consideration of eyelid contour in patients with TED may improve corrective surgery for eyelid retraction.