Normal upper eyelid rests just below the upper border of the cornea/iris, while normal lower eyelid rests at the lower border of the cornea/iris. Eyelid retraction is abnormal elevation of the upper eyelids and abnormal lowering of the lower eyelids.

What Causes Eyelid Retraction?

There are various causes of eyelid retraction, including congenital, thyroid eye disease (Graves’ disease), trauma, and prior surgery. The most common cause of lower eyelid retraction is from complications from prior lower blepharoplasty, where either scar tissue developed and/or if too much skin was excised from the lower eyelid. Lower eyelid retraction can appear as rounding of the eyes. It can lead to chronic eye conditions including dry eyes, excessive tearing, redness, burning and blurred vision.

Treatment

The first line of therapy is ocular protection using frequent ocular lubrication (drops and ointment), bandage contact lens, etc. Surgery is inevitably needed since the eyes will get more dry as time progresses. There are various surgical techniques, usually performed via a posterior (hidden) eyelid approach. At times, grafts and/or midface (cheek) lift may be needed. Tightening of the lower eyelid is usually concurrently performed.

Dr. Taban has written several articles on eyelid retraction surgery, including:

Efficacy of “Thick” Acellular Human Dermis (AlloDerm) For Lower Eyelid Reconstruction
Comparison of AlloDerm and Hard Palate grafts

“En-Glove” Lysis of Lower Eyelid Retractors With AlloDerm and Dermis-Fat Grafts in Lower Eyelid Retraction Surgery
New minimally invasive, scarless technique for lower eyelid retraction surgery

See Dr. Taban’s article: Minimally Invasive Englove Approach For Eyelid Retraction Surgery

Lower eyelid retraction.

Before (left) and after (right) bilateral lower eyelid retraction surgery with internal dermis-fat graft.

Eyelid Retraction

Before (left) and after (right photo) of right upper eyelid ptosis surgery, left upper eyelid retraction surgery and bilateral lower blepharoplasty.

3 months after left upper eyelid retraction surgery.

Before (left) and 3-months after (right) left upper eyelid retraction surgery.

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