{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T14:50:20Z","timestamp":1771858220281,"version":"3.50.1"},"reference-count":111,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n            <jats:title>Purpose:<\/jats:title>\n            <jats:p>Graves lower eyelid retraction (GLLR) is a common and controversial sign of Graves orbitopathy. The authors reviewed the mechanisms and surgical techniques currently used to correct this Graves orbitopathy-related eyelid malposition.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A literature search was performed on the MEDLINE database using the keywords \u201clower eyelid retraction,\u201d \u201cGraves orbitopathy,\u201d \u201cthyroid ophthalmopathy,\u201d \u201cthyroid eye disease,\u201d \u201cspacers,\u201d and \u201ceyelid surgery.\u201d Only articles in English were included. The level of evidence of publications regarding surgical correction of GLLR was evaluated and graded from I to IV, using a rating system adapted from a validated scientific evidence classification method.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The mechanisms responsible for GLLR are not fully understood and no subtypes of GLLR have been distinguished. The surgical literature of GLLR encompasses mainly descriptions of surgical techniques without objective measurements of the results, and uncontrolled studies. Only 1 randomized controlled trial was identified. To lengthen the lower retractors, a large variety of different materials have been used as spacers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The scientific literature on GLLR is vast, however controlled and randomized studies comparing different surgical techniques are lacking. At the present moment it is not clear if bioengineered materials are superior to conventional autogeneous tissue as lower eyelid spacers. The effects of GLLR on lower eyelid movements and contour have not been studied.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/iop.0000000000000613","type":"journal-article","created":{"date-parts":[[2016,1,19]],"date-time":"2016-01-19T19:41:05Z","timestamp":1453232465000},"page":"161-169","source":"Crossref","is-referenced-by-count":30,"title":["Graves Lower Eyelid Retraction"],"prefix":"10.1097","volume":"32","author":[{"given":"Sara Filipa Teixeira","family":"Ribeiro","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Cl\u00ednicas-Campus, School of Medicine of Ribeir\u00e3o Preto, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil"}]},{"given":"Maria","family":"Shekhovtsova","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Cl\u00ednicas-Campus, School of Medicine of Ribeir\u00e3o Preto, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil"}]},{"given":"Ana Filipa","family":"Duarte","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Cl\u00ednicas-Campus, School of Medicine of Ribeir\u00e3o Preto, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil"}]},{"given":"Antonio Augusto","family":"Velasco Cruz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Hospital das Cl\u00ednicas-Campus, School of Medicine of Ribeir\u00e3o Preto, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, S\u00e3o Paulo, Brazil"}]}],"member":"276","reference":[{"key":"R1-20230817","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/S0002-9394(14)72787-4","article-title":"Diagnostic criteria for Graves\u2019 ophthalmopathy.","volume":"119","author":"Bartley","year":"1995","journal-title":"Am J Ophthalmol"},{"key":"R2-20230817","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.survophthal.2012.02.007","article-title":"Graves upper eyelid retraction.","volume":"58","author":"Cruz","year":"2013","journal-title":"Surv Ophthalmol"},{"key":"R3-20230817","first-page":"492","article-title":"Graves\u2019 eye disease: orbital compliance and other physical measurements.","volume":"82","author":"Frueh","year":"1984","journal-title":"Trans Am Ophthalmol Soc"},{"key":"R4-20230817","first-page":"572","article-title":"Ocular manifestations of thyroid disease: current concepts.","volume":"57","author":"Day","year":"1957","journal-title":"Trans Am Opth Soc"},{"key":"R5-20230817","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1001\/archopht.1990.01070110155041","article-title":"Management of lower-lid retraction with hard-palate mucosa grafting.","volume":"108","author":"Kersten","year":"1990","journal-title":"Arch Ophthalmol"},{"key":"R6-20230817","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1136\/bjo.82.2.174","article-title":"Correction of lower eyelid retraction in thyroid eye disease: a randomised controlled trial of retractor tenotomy with adjuvant antimetabolite versus scleral graft.","volume":"82","author":"Olver","year":"1998","journal-title":"Br J Ophthalmol"},{"key":"R7-20230817","first-page":"1193","article-title":"The periodic health examination. 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