Eyelid retraction happens when your eyelid doesn’t cover your eyeball sufficiently when you are in a normal, resting position and neither surprised nor excited. Instead of resting comfortably over your eye, either the upper lid is too high up or the lower lid is too far down. It’s not normal, since your eyelids are supposed to cover your eyes easily and completely.
When your lids retract, your appearance changes. But more importantly, the condition can be very uncomfortable. In addition to bulging eyes, symptoms of lid retraction can lead to:
- A dry, gritty feeling in your eyes
- Difficulty closing your eyes
- Scarring that leads to vision loss
- Fatty deposits developing
- Tearing due to reflex watering
- Double vision
- Blurred vision
- The appearance of staring all the time
The most commonly seen cause of eyelid retraction is an over-active thyroid gland, a medical condition called Graves disease. Thyroid ophthalmopathy occurs when your thyroid gland isn’t stable. While other symptoms accompany thyroid disease, such as hyperactivity and an inability to gain weight, very often it’s the bulging eyes that give away the underlying condition.
Other causes of eyelid retraction include:
- Midbrain disease
- Failed eyelid surgery
- Cushing syndrome
- Facial palsy
- Trauma or injury to your eye
Upper Lid Retraction Surgery
Surgery to correct eyelid retraction is done in the doctor’s office under light intravenous sedation. You get local injections to completely numb the area being treated. You remain sitting in an upright position for the procedure so that your doctor can gauge the symmetry of his work as he proceeds. You want your affected eyelid to lie in a normal position, which requires that the doctor continually review his work during the length of the surgery.
With meticulous attention to detail, you may be able to get your lid retraction surgery completed in one session. Touch-up work to align the lids is required in about 10 to 15 percent of the cases. When you have significant eyelid retraction that affects your vision, it’s considered a medical necessity and it’s usually covered by insurance. When the eyelid retraction is minimal, many insurance companies consider the procedure to be cosmetic.
Lower Lid Retraction Surgery
The fibrotic muscle in your lower eyelid is removed when the lower lids are treated for lid retraction. Spacer material, often taken from other skin on your body, is used to push up the lid to its proper position. Skin is sometimes taken from your inner ear or from the inside of your mouth. Once the material is in place, the tendons around your eye are tightened to reposition the outer layer of your lower lid.
Asymmetry is uncommon in lower lid retraction surgery. It’s not as obvious as work done on your upper lids. The procedure is usually considered medically necessary, as lower lid retraction is especially painful, causing your eyes to stay dry all the time.
Combined Service and Recovery
When thyroid patients undergo upper and/or lower eyelid retraction surgery, they often elect to have eyelid blepharoplasty done at the same time. During the elective procedure, the doctor removes excess fatty tissue to give your eyes a more appealing appearance.
Redundant upper and lower eyelid skin can be cut off while you are sedated. And you’ll have to undergo some level of healing — with an eye patch and time off — so it’s a good time to consider the extra work, even though you may have to pay for a portion of the procedure yourself. Insurance companies typically don’t recognize blepharoplasty medically necessary.
Another plastic surgery procedure that you may want to consider at the same time is an eyebrow lift. By surgically moving your eyebrows up on your forehead, you may alleviate some of the pressure that was pushing excess skin over your eyes. Your appearance and your vision may benefit from an eyebrow lift concurrent with your lid retraction surgery.
Most likely, you can go home within an hour after your procedure. It’s best to have someone available to drive you home since you may be fuzzy from the anesthesia. Your initial post-operative care consists of the following instructions:
- Keep your head elevated
- Apply ice packs to the treated eye for 30 minutes on and 30 minutes off for the first two days following surgery
- Apply topical antibiotic ointment as directed
- Take narcotic pain medication for the first week as needed
- Don’t rush; you need five to 10 days of bedrest before you can return to work or your regular activities
Chances are you’ll have considerable swelling after the procedure, especially if you had the surgery to correct thyroid side effects. If you underwent eyelid retraction surgery for cosmetic reasons, you may not need to wait as long for the swelling to recede. Within about a week, 70 to 80 percent of the swelling should be gone, with 90 percent gone by the end of the second week.
Additionally, scar tissue may make your eyelids feel stiff and difficult to move smoothly. Bruising is apparent for about a week. This is common, but it lessens with time.
The purpose of eyelid retraction surgery is to either lower or raise the margins on your lids to cover your eyes appropriately and alleviate your uncomfortable symptoms. A side effect may be improving your vision. The trauma of surgery and the associated incisions leave you puffy for a week or more, so your results aren’t immediately noticeable.
Ensure your ophthalmologist has experience performing eye retraction surgery to get the best care. While eyelid retraction surgery generally is safe and successful with few repeat procedures needed, there are associated risks with the procedure that include:
- Persistent numbness around your eyes
- Wound infection
- Corneal abrasion or a scratch on your eye that heals within two days
- Bleeding that could lead to blindness
- Overcorrection, meaning the lid was moved too high or too low
- Contour abnormalities, in which the lid appears uneven
- Impaired vision, which is very rare
- Acute glaucoma, also very rare
Few options exist other than surgery to correct eyelid retraction. Botox injections may stop the retraction from worsening, but that only postpones the inevitable. Eye drops can make your eyes feel better. But the problem cannot be corrected without surgery.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.
Do you have any questions about eyelid retraction, lid surgery or repair? Would like to schedule an appointment with NYC leading Ophthalmologist or Optometrist, Dr. Saba Khodadadian of Manhattan Eye Specialists, please contact our office for consultation with leading NYC Eye doctor.
Dr. Saba Khodadadian, Optometrist (NYC Eye Doctor)
New York, NY 10010
(Between Madison Ave & Park Ave)
☎ (212) 533-4821