What is lower eyelid retraction?
Lower eyelid retraction is a condition where the eyelid sits too low on the eye. Normally, the lower eyelid sits right at the colored part of the eye called the iris or covers it slightly. Retracted eyelid is pulled down, which results in a rounded appearance of the eye rather than a more natural, โalmondโ shape. Prior surgery, trauma or facial paralysis can lead to the eyelid sagging exposing more of the white part of the eye called the sclera. This condition is different from ectropion, where the eyelid is pulled outward, away from the eye. Eyelid retraction can cause irritation, discomfort, tearing, crusting and eventual compromise of vision.
What are the symptoms of lower eyelid retraction?
Lower eyelid retraction is common especially after any lower eyelid or orbital surgery. Patients with facial paralysis also experience eyelid retraction, because paralyzed muscle around the eye loses tone leading to sagging of the eyelid. Younger patients with facial paralysis will typically develop retraction rather than ectropion, which is where the eyelid everts away from the eye.ย
As the eyelid sags exposing more sclera (white part of the eye), the patientโs eye closure is impaired which leads to burning, dry eye, tearing and visible asymmetry. Severe eye irritation can lead to inflammation and abrasions of the cornea, which is the outer surface of the eye. Repeat corneal trauma can result in ulcerations, infections and eventually compromised vision.
What causes lower eyelid retraction?
There are many causes of eyelid retraction. It is important to be evaluated by a specialist to understand the exact cause:
Facial paralysis. Retraction can result from loss of eyelid tone in flaccid facial paralysis or early stages of Bellโs palsy. It is more common for younger patients to develop eyelid retraction rather than ectropion or eyelid eversion.
Prior surgery. Patients who underwent prior eyelid surgery for both functional and cosmetic reasons can develop lower eyelid retraction and apparent rounded appearance of the eye. The history of orbital surgery is also a risk factor for lower eyelid retraction.
Trauma. Repeat trauma to the eyelid, orbital trauma repair, or history of repeat pulling on the eyelid, including contact lens wears, can cause lower eyelid retraction.ย
Age. Lower eyelid retraction could develop due to normal aging. The lower eyelid is supported on each side by canthal tendons essentially like a hammock. Stretching out of the supporting tendons leads to a sagging, loose eyelid. The middle third of the face is also important in lower eyelid support. With age, there is sagging of the midface leading to gravitational, downward pull on cheeks and the lower eyelid which further contributes to eyelid eversion and stretching of the canthal tendons.ย
Illness. There are certain classifications of illnesses that can cause upper and lower eyelid retraction including thyroid disease or systemic illness. It is important to be fully evaluated by a specialist that can rule out any underlying diseases.
How is lower eyelid retraction diagnosed?
Patients may notice your eye feeling drier and more of the white part of the eye below the colored iris showing. This will lead many patients to see their doctor.ย A routing examination including a history and physical can be used to diagnose eyelid retraction. The history of the symptoms listed above can direct the physical exam. The doctor may perform an โeyelid distraction testโ or a โsnap-back testโ, where they will pull on your lower eyelid and measure how far and how quickly the eyelid returns to the globe. Inability of the eyelid to return to its normal position under the iris may indicate excess scar from prior trauma or surgery and will guide treatment.
How is eyelid retraction treated?
Mild lower eyelid retraction can be treated medically. However, these treatments will not raise the eyelid back to its normal position. Eye irritation can be treated with increased lubrication of the eyelid including over-the-counter natural tear drops or ophthalmic ointments. Patients with more severe retraction or facial paralysis may need to tape the eye shut at night to avoid eye injury during sleep. For patients with facial paralysis, eyelid stretching exercises may be recommended by your doctor to try to help close the eye.ย
Surgical correction depends on severity of the retraction as well as the cause. Underlying causes such as systemic or thyroid disease need to be either stabilized or controlled medically. Lower eyelid retraction is treated surgically based on the cause and amount of scar tissue causing the retraction itself. If there was loss of the inside of the eyelid due to trauma or scar, it may need to be substituted by similar tissue from another site of the body. If scar tissue from prior injury or surgery is contributing to eyelid retraction, grafting of either skin, cartilage or the inner lining of the mouth may be necessary to restore proper eyelid function. Both age-related correction or facial paralysis correction may include lifting the middle third of the face that has fallen (midface lift) and pulled the lower lid inferiorly. Dr Araslanova can guide you through both medical and surgical options depending on the severity of the lower eyelid retraction.