The article “Graded full-thickness anterior blepharotomy for upper lid retraction” by Elner et al1 describes a method that Dr Leo Koornneef developed but did not publish himself because of his early death. The authors describe full-thickness blepharotomy, that is, incision of the levator aponeurosis, Mueller muscle, and conjunctiva in all patients, irrespective of their lid height. They started the incision at the junction of the lateral and central thirds of the eyelid and cut medially and laterally in a graded manner until they achieved an “eyelid height” of 2 to 4 mm (do they mean margin-reflex-distance?) in the sitting patient. If there was temporal flare, the lateral horn of the aponeurosis was also incised. They did not open the septum, and they preserved the fat pads.
Ettl A. Koornneef’s Graded Upper Lid Lengthening in Graves Disease. Arch Ophthalmol. 2005;123(6):871–872. doi:10.1001/archopht.123.6.871
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