Exploring successful treatments for upper eyelid retraction in thyroid eye disease: A scoping review

Graves-associated upper eyelid retraction (GAUER) is a functionally and cosmetically significant manifestation of thyroid eye disease. This scoping review maps the breadth of evidence on medical and surgical management of GAUER, synthesizes outcomes, and identifies evidence gaps. A systematic search identified 65 studies published between 1965 and 2025. Studies were categorized as medical or surgical interventions, with marginal reflex distance 1 serving as the most consistently reported outcome for weighted analysis. Among medical interventions, triamcinolone acetonide remains the most widely studied, though recent randomized clinical trials suggest betamethasone achieves faster and longer-lasting improvement with fewer injections. Botulinum toxin A and hyaluronic acid fillers offer safe, reversible options for transient or mild retraction, while the biologic teprotumumab shows modest but consistent benefit, particularly in muscle-predominant disease. Surgical correction remains the standard for fibrotic or refractory cases, with full-thickness anterior blepharotomy and levator-Müller complex recession yielding the most predictable, durable, and aesthetically balanced results. Interpretation of available data is limited by methodological heterogeneity and a lack of standardized endpoints. Aesthetic outcomes were inconsistently reported. Future prospective comparative studies incorporating both functional and aesthetic outcomes are essential to establish evidence-based, phase-specific treatment strategies for GAUER.