Eyelid retraction is defined as inferior displacement of the lower lid and/or superior displacement of the upper lid from the normal anatomical position. It is important to note that the eyelid margin position may be normal i.e. this is often not seen with ectropion or entropion. It is most commonly seen with thyroid conditions, but other risk factors include previous trauma and chronic sun exposure.
Patients may complain of chronic ocular redness, irritation and foreign body sensation. Since the tear-duct opening is on the eyelid itself, lid retraction causes an inability to drain the normal tears and patients also complain of tearing. Clinical evaluation may show evidence of lagophthalmos.
Patients need to be reminded to avoid wiping their eyelids in a horizontal or downwards fashion. Reducing sun and UV exposure may also help to prevent some cases of lid retraction. Rarely, correction of the underlying thyroid condition may help lessen the lid retraction.
In the early stages of the disease, relief may be obtained by wiping the eyes in a vertical manner and avoiding any horizontal traction on the eyelids.
Most patients with lid retraction can be initially managed with topical lubricating drops during the day and lubricating gels at night. If patients are otherwise asymptomatic, no surgery is necessary. If the lid retraction has been longstanding and severe, skin-grafting procedures may be required.