One of the more distressing components of the orbital and ocular changes that accompany Graves' disease is the alteration in the position of the eyelids, commonly termed "lid retraction." In the upper eyelids this retraction is probably due to some abnormality in the elevator muscles (most likely the levator palpebrae superioris). In the less frequent but sometimes definite retraction of the lower eyelids, the abnormality is probably located in the musculofascial connections between the tarsal plate and the sheath of the inferior rectus muscle. This lid retraction, whether it involves the upper or the lower eyelid, or both, is usually responsible for the "stare" that people with thyroid dysfunction so often exhibit. This widening of the palpebral fissures is not, as is sometimes loosely implied, a passive change brought about by the forward protrusion of the eye. When both true exophthalmos and lid retraction are present in the same individual,
HENDERSON JW. Relief of Eyelid Retraction: A Surgical Procedure. Arch Ophthalmol. 1965;74(2):205–216. doi:10.1001/archopht.1965.00970040207015
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