Orbital
Rehabilitative surgery for thyroid eye disease — correcting eyelid retraction and the restrictive strabismus that causes double vision, after the orbit is stable.
Medically reviewed by Christine Annunziata, MDOculoplastic SurgeonLast updated June 2026
Part of our complete guide to Thyroid Eye Disease (TED) — this page covers TED eyelid and strabismus surgery in depth.
Once thyroid eye disease has stabilized, two of its most disabling effects — a retracted, staring eyelid and double vision from tight eye muscles — are corrected surgically. These are the rehabilitative steps that follow orbital decompression.
Eyelid retraction is among the most common and distressing features of TED. The upper lid normally covers 1–2 mm of the superior limbus; in TED it may sit above the limbus entirely, exposing the sclera and giving the characteristic staring appearance.
Eyelid surgery is the last step in the sequential rehabilitation of TED (after decompression and strabismus if needed), performed once disease is stable for ≥ 6 months.
The animation below steps through the surgical correction of lower-eyelid retraction — recession of the lower-lid retractors, with or without a spacer graft — via both the external (transcutaneous) and internal (transconjunctival) approaches.
Choose a section, then drag the slider to step through it.
Step 1 of 4
Front-view anatomical illustration highlighting the relevant anatomy of the lower eyelid.
Drag the slider to compare
Drag the divider left or right to compare. Use arrow keys when focused.
Diplopia (double vision) in TED results from restrictive strabismus — the inflamed, fibrotic extraocular muscles tether the eye and prevent full movement, causing misalignment. Unlike paralytic strabismus, TED strabismus features a positive forced duction test (the eye cannot be passively moved through full range).
Your Surgeon
Christine Annunziata, MD
Metrolina Eye
🏅 ASOPRS Fellowship Trained
Schedule a consultation with Christine Annunziata, MD to learn if this procedure is right for you.
