Eyelid Retraction Surgery

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

What Causes Eyelid Retraction?

There are various causes of this eye condition, including congenital, thyroid eye disease (Graves’ disease), trauma, and prior surgery. Most common cause of retraction of the upper eyelids is thyroid disease followed by genetics. The most common cause of lower eyelid retraction is from complications from prior lower blepharoplasty (post-blepharoplasty retraction), where either scar tissue developed and/or if too much skin was excised from the bottom eye fold. This eye condition can appear as eye rounding and scleral show and very importantly it results in surgical (unnatural) eye and facial appearance. It can lead to chronic eye conditions including dry eyes, excessive tearing, redness, burning and blurred vision.

Another common cause of retraction of the lower eye fold is genetics, where the lower eyelids are too low with scleral show. These patients often complain about their eye shape while desiring more almond shape eyes. They want surgery to correct the scleral show. It is important to understand that sometimes large eyeballs or bulging eyes can force the bottom eyelids to be too low, which means sometimes the eyeballs have to be set back (through orbital decompression) to allow the lower eyelids to come up. A good analogy to consider is someone’s pants can fall down if the belly is too big!

Treatment

The first line of therapy is ocular protection using frequent ocular lubrication (drops and ointment), bandage contact lens, etc. Oculoplastic surgery is inevitably needed since the eyes will get more dry as time progresses. This eye condition surgery are done differently. For upper eyelid surgery, the levator muscle (responsible for lifting the upper eye fold) is cut to lower the upper eyelid.  Oculoplastic surgery for retraction of the bottom eyelids works differently. There are various surgical techniques, usually performed via a posterior (hidden) approach. At times, grafts and/or midface (cheek) lift may be needed to help elevate the bottom eyelid and reduce the scleral show. Tightening of the lower eyelids is usually concurrently performed through canthoplasty where the outer eye corner is tightened. Lower eyelid retraction surgery can help achieve more almond shape eyes.

At times, orbital decompression may be necessary as an initial step (prior to this oculoplastic surgery) if big eyeballs or bulging eyes are forcing the lower eye fold too low. Going back to the previous analogy, if someone’s big belly is reduced, the their pants can come up higher!

Addition information on oculoplastic surgery can be found on AAO.org.

Before & After Photos

Dr. Taban is an expert LA oculoplastic surgeon, using minimally invasive techniques, helping patients locally and around the world with this difficult problem, in his 2 offices in the greater Los Angeles area (Beverly Hills and Santa Barbara).

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