Eyelid Retraction/Lid Lag

What Is Lid Lag?

Eyelid retraction, also known as lid lag, is a condition in which the upper eyelid is abnormally positioned, exposing more of the iris and, in some cases, the white part of your eye. Lower eyelid retraction, which is less common, occurs when the lower eyelid is positioned lower than normal, resulting in a droopy appearance and likely exposes the lower part of the iris. This can make is seem as if you’re startled or staring wide-eyed, generating concerns about your appearance and overall health.

While not as common as other eye conditions such as refractive errors or dry eye syndrome, eyelid retraction is a significant worry for those affected due to its potential impact on vision, appearance and general well-being of the eyes. Eye Physicians in NYC has a team of trained optometrists and eye doctors dedicated to correctly diagnosing and managing lid lag. Their quick and competent eyelid retraction repair restores normal eyelid function and relieves any associated pain.

Other than eyelid retraction repair, their practice also offers treatment options for a wide range of other conditions too for your entire family, including children, such as for:

• Uncontrolled eye movement
• Optic neuritis
• Color blindness
• Sunburned eyes
• Pink eye

What Are the Symptoms of Eyelid Retraction?

Symptoms of eyelid retraction vary depending on the underlying cause and severity of the disease. If you’re experiencing eyelid retraction along with symptoms, however, such as dryness or discomfort, you should seek medical attention immediately. The most common symptoms of lid lag include:

• Elevated upper eyelids revealing more iris and, in some cases, the sclera, which is the white part of your eyeball on the outer layer
• Unintentional staring or wide-eyed expressions
• Dryness, irritation and discomfort
• Difficulty closing your eyes
• Sensitivity to light

Lid lag is a functional disability that affects eyesight and blinking. Aside from these common symptoms, eyelid retraction might create more complicated symptoms. Some of the more complicated symptoms related to eyelid retraction can include:

• Corneal ulceration, incomplete eyelid closure, which may cause corneal injury
• Exposure keratopathy, prolonged exposure that might cause corneal dryness and clouding
• Diplopia, also called double vision that, in this case, is caused by improper eye muscle function
• Vision loss, when severe cases or underlying diseases result in irreparable loss
• Cosmetic concerns, such as enlarged eyes and asymmetry that can lead to a lack of confidence and low self-esteem

What Are the Causes of Eyelid Retraction?

Eyelid retraction that leads to a need for lower eyelid retraction surgery or surgical repair of the eyelid can be caused by a variety of factors, including:

• Thyroid eye disease, called Graves’ disease, which causes inflammation and swelling of the tissues surrounding the eyes
• Damage to the facial nerve that upsets the balance of muscles that control eyelid movement
• Eyelid injuries or burns that leave scars and cause muscular damage
• Neurological diseases include Moebius syndrome, which affects the muscles that control eye movement
• Conditions like myasthenia gravis, which weakens muscles and might impair the ability of the eyelids to close properly
• Complications from eyelid procedures, such as ptosis correction or blepharoplasty
• Growth on the eyelids that mechanically impairs correct eyelid function
• Congenital problems or irregularities in eyelid development
• Trauma or certain medications

Eyelid retraction is diagnosed after a thorough medical history and physical examination by an eye specialist. This includes evaluating eyelid posture and movement. Measurement techniques measure the extent of retraction, and imaging procedures such as ultrasound or MRI scans identify structural problems. Blood testing detects thyroid dysfunction or autoimmune diseases.

What Does Eyelid Retraction Repair Look Like?

Early diagnosis and appropriate management make effective treatment possible. Treatment options for eyelid retraction vary depending on the underlying cause and severity of the condition. Some frequently used treatments include:

• Artificial tears and lubricating ointments that reduce dryness and irritation caused by eyelid retraction
• Certain exercises recommended by an ophthalmologist to strengthen the muscles surrounding the eyes and improve eyelid posture
• Botox injections into the muscles that lift the eyelid to temporarily reduce its position
• Surgical repair of the eyelid using small weights that are inserted into the eyelids to help them close properly

If eyelid retraction is caused by an underlying disease, such as thyroid eye disease, the condition must be treated appropriately to properly control the retraction. Other than these approaches, surgical repair of the eyelid may be required, particularly if the retraction is significant or causing vision loss. Several eyelid retraction surgery methods can be performed based on your needs, including:

• Eyelid lengthening. This involves releasing scar tissue or tightening the eyelid retractors to lower the eyelids.
• Graves’ disease treatment. For eyelid retraction caused by Graves’ disease, orbital decompression surgery may be required to relieve pressure on the eye and enhance eyelid posture.
• Canthoplasty or canthopexy. These operations involve tightening or relocating the lateral canthal tendon to rectify the posture of the eyelids.
• Grafting. Grafts can be used to repair and restore the posture of an eyelid in cases with severe scarring or tissue loss.

Lower lid retraction surgery is an option when conservative treatments such as artificial tears, lubricating ointments or eyelid workouts are ineffective, or when the retraction is significant and causes functional or cosmetic problems. Lower eyelid retraction surgery seeks to rectify the position of the lower eyelid about the eye, restoring normal eyelid function and appearance. Common surgical procedures for lower lid retraction include:

• Horizontal tightening. The lateral tarsal strip surgery involves removing and reattaching tissue to tighten the lower eyelid horizontally.
• Midface lifting. Lifts and repositions midface tissues to stabilize the lower eyelid and rectify downward displacement.
• Lower eyelid retractor release. Tight or scarred lower eyelid retractors are surgically released, allowing for better lower eyelid positioning.
• Lower eyelid spacer grafts. Implants comprised of cartilage or synthetics support and maintain the lower eyelid’s posture.

Lower eyelid retraction prevention involves using precautions during activities, leading a healthy lifestyle, not smoking, practicing proper eye care and getting regular eye checkups. Don’t let eyelid retraction affect your vision or confidence. Contact the skilled doctors at Eye Physicians in NYC. With their experience and individualized treatment, you can feel confident that your problem will be properly addressed and with each visit, you can be assured of getting in and out of the office in under an hour.

Page Updated on Jun 10, 2024 by Dr. William Hogue, OD (Optometrist) of Eye Physicians

Eye Physicians
110 Lafayette St, Suite 503
New York, NY 10013
(212) 292-4814

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