Eyelid retraction is when one of the two eyelids (upper or lower) is more open than normal.
When it occurs in the upper eyelid, it usually produces a startled face and a “bulging eye” appearance. It is almost always due to thyroid orbitopathy (eye involvement due to thyroid problems). The treatment of eyelid retraction in the initial stages is the treatment of the orbitopathy itself. When the retraction remains after treatment of the orbitopathy, it can be corrected with surgery. There are different techniques for the correction of upper eyelid retraction. All of them are performed under local anaesthesia and intravenous sedation. It is very important to fully individualise the type of surgery according to the characteristics of each patient, as this way we can optimise the result of the surgery. The surgery usually manages to normalise the position of the eyelids.
When it occurs in the lower eyelid, it often produces the appearance of sad, tired eyes. Unlike upper eyelid retraction, lower eyelid retraction has many other possible causes. One such cause is retraction after lower blepharoplasty. Risk factors for this tend to be eyelid laxity prior to surgery, extensive skin excision and scarring of the inner layers of the eyelid (increased risk when blepharoplasty is performed through the skin rather than through the conjunctiva). When it appears, it is usually possible to correct it with surgery, generally by re-tightening the eyelid, raising the cheek with a midface lift associated with the use of grafts, generally of the palate.
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