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Lid Retraction

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WHAT IS UPPER LID RETRACTION AND HOW IS IT CORRECTED?

Upper lid retraction is a condition that occurs when one or both upper eyelids are higher than they should be and the edge of the upper eyelid is above the uppermost portion of the colored part of the eye. This is most commonly caused by Graves Disease or Thyroid Related Eye Disease. This can result in an increased dry eye and eye irritation or a foreign body sensation in addition to the inability to close the eye (called lagophthalmos). This, in severe cases, can lead to scarring of the cornea or infections of the cornea resulting in vision loss. Finally, the appearance of the eye will frequently have a “startled” or “surprised” appearance.

To correct eyelid retraction of the upper lid, the surgeon needs to make an incision or cut the skin of the upper eyelid in order to reach the muscles and tendons. The muscles are detached and sometimes the incision goes all the way through the eyelid through the conjunctiva.

HOW WILL UPPER LID RETRACTION SURGERY AFFECT MY VISION AND APPEARANCE?

The upper lid retraction surgery does not improve the vision but allows for improvement in dry eye syndrome by decreasing how much of the eye is covered by the eyelid. It decreases the evaporation of the natural tears of the eye much like closing a pool cover to decrease the evaporation of water out of the pool on a hot day. It can also improve how much the eye closes at night time if incomplete closure exists.

WHAT ARE THE MAJOR RISKS OF UPPER LID RETRACTION SURGERY?

Risks of upper lid retraction surgery, like most eyelid surgical procedures include but are not limited to: bleeding, infection, an asymmetric or unbalanced appearance, scarring, persistent difficulty closing the eyes (which may cause damage to the underlying corneal surface), over-correction resulting in a “droopy eyelid”, difficulty with or inability to wear contact lenses, double vision, tearing, or persistent dry eye problems, numbness and/or tingling in the operated eyelid, near the eye, or on the face, and in rare cases, loss of vision including blindness. The condition can recur and under correction (persistent upper lid retraction) after surgery is possible. If it does, you may need to have repeat surgery.

The result of upper lid retraction surgery cannot be guaranteed. Upper lid retraction surgery involves surgery on the tendon and/or muscle inside the eyelid, which can make the results unpredictable. At times, the surgeon may need to adjust the position and shape of the eyelid after lid retraction surgery. The adjustments can be done early (within the first ten days) after surgery, or later on if asymmetry of the eyelid position or shape occurs. The final result depends upon your anatomy, your body’s wound healing response, and the underlying cause of the ptosis. Some patients have difficulty adjusting to changes to their appearance. Some patients have unrealistic expectations about how changes in appearance will impact their lives.

WHAT ARE THE ALTERNATIVES TO LID RETRACTION SURGERY?

Patients can live with an upper lid that is too high; however, there is no reliable method to correct upper lid retraction on a permanent basis without surgery. Patients who are too sick to have surgery benefit from sewing the two lids together to help control dry eye which can be done in the office. Botox can be considered as well but it will wear off typically in 2-3 months

WHAT TYPE OF ANESTHESIA IS USED AND WHAT ARE ITS RISKS

In children, general anesthesia is necessary. In teenagers and adults, surgery can usually be performed on an outpatient basis under local anesthesia with sedation depending on the need and location. IV sedation is frequently used. Risks of anesthesia, when administered, include but are not limited to damage to the eye and surrounding tissues and structures, loss of vision, breathing problems, and, in extremely rare circumstances, stroke or death.

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