Lid Retraction

In lid retraction, the upper lid sits too high or the lower lid too low, exposing more of the white of the eye.

• Thyroid eye disease is the most common cause.
• Other causes include scarring after injury or previous eyelid surgery, facial nerve weakness, and a prominent eye.
• It can cause a dry, sore, gritty or light-sensitive eye, especially if the lids do not close fully.

In thyroid eye disease, blurred vision or colours looking faded needs urgent assessment.

• Measurements of the eyelid position and closure, and an examination of the eye surface.
• Thyroid blood tests, and a CT or MRI scan when thyroid eye disease is suspected.

• Most people need only lubricating drops and gels to protect the eye.
• Injections (such as botulinum toxin) can lower the upper lid temporarily.
• Surgery releases the muscles that pull the eyelid up (upper lid) or down (lower lid). Sometimes a spacer graft, for example from the roof of the mouth, is used to lengthen the lid.
• In thyroid eye disease, eyelid surgery is done only after the disease has been stable for at least six months, and after any orbital or squint surgery.

• Usually under local anaesthetic as a day case, through a cut in the eyelid crease, and takes about 30 to 45 minutes.
• The lids are sometimes stitched together temporarily for about a week.
• Bruising can take three to four weeks to settle. Avoid swimming and heavy exercise for about four weeks, and contact lenses for at least two weeks.

Every operation carries some risk. Your doctor will go through the risks that apply to you before you decide.

• The eyelid may end up slightly too high or too low, uneven, or with an irregular curve. A further adjustment is sometimes needed.
• The retraction can come back.
• Scarring, and problems at the site from which a graft was taken.