Surgical plastic procedures can alleviate some of the ocular disability and cosmetic defects related to ocular complications of Graves' disease. These operations may include (1) maximal recession of a fibrotic inferior rectus to relieve hypotropia from its "leash effect," (2) bilateral recession of inferior rectus muscles to relieve restriction to upward gaze, (3) recession of other extraocular muscles to correct heterotropia and diplopia, (4) orbital decompression for severe exophthalmos by multiple routes, including inferior orbital decompression into the antrum, (5) block recession of levator, Mueller's muscle, and conjunctiva for marked lid retraction, (6) excision of pockets of fat from bulging upper and lower lids, (7) tightening of loose redundant lid skin by blepharoplasty, and (8) lateral tarsorrhaphies. Combined operations using these principles to correct multiple defects are justified by the good results reported in a series of patients.
Schimek RA. Surgical Management of Ocular Complications of Graves' Disease. Arch Ophthalmol. 1972;87(6):655-664. doi:10.1001/archopht.1972.01000020657009