Eyelid scarring and retraction can occur when injury, surgery, thyroid eye disease, aging, or other conditions pull the eyelids out of their normal position. When the upper eyelid sits too high or the lower eyelid is pulled downward, the eye may not be fully protected, leading to dryness, irritation, tearing, blurry vision, pain, and possible corneal damage.
At Fante Eye & Face Center, patients from Denver, Greenwood Village, and surrounding Colorado communities receive eyelid scarring and retraction treatment from doctors with advanced training in eyelid function, ocular surface protection, and oculofacial plastic surgery. Dr. Robert Fante is double board-certified and a fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery, while both Dr. Levitt and Dr. Huang are ASOPRS-trained surgeons and ASOPRS Candidate Members. This specialized expertise helps the team restore eyelid position while maintaining eye comfort, vision protection, tear function, and appearance.
What Causes Eyelid Damage?
Damage to the eyelids can be caused by surgery on the eyelids or nearby parts of the face. Cosmetic and non-cosmetic eyelid or facial surgery as well as skin cancer (Mohs) reconstruction are common causes of eyelid retraction. Scarring from a traumatic injury (such as dog bite, car accident, or fistfight) can also lead to eyelid retraction. Due to the unique anatomy of the eyelid, repair can be a challenge. However, it is crucial that the injured person receives proper treatment to address cosmetic and ocular concerns. Our Denver doctors have extensive training in ophthalmic and oculoplastic surgery and have many years of clinical experience treating simple to complex cases of eyelid trauma.
Although damage from previous surgery or trauma accounts for most cases of eyelid retraction, Thyroid Eye Disease (Graves), and age related changes will sometimes cause eyelid retraction. The symptoms are usually the same (eye irritation and tearing especially) but since they come on gradually, patients may not realize that something is wrong. Fortunately, treatment for age-related and thyroid-related retraction is available, just as it is for the traumatic and post-surgical types of retraction.
What is Eyelid Scarring?
Eyelid or facial surgery or trauma can cause the eyelids to lose normal mobility and position. In some cases, this scarring may make it impossible to properly close the eye(s) so that drying, irritation, and infection can result. When the lower eyelid is affected, patients may notice that there is ‘too much white showing,’ and the eye often alternates between feeling gritty and watering excessively. Outpatient surgical repair can usually restore more normal appearance and function. Our doctors will perform a careful examination during your consultation to determine the exact details of the repair that will be required.
What is Eyelid Retraction?
Eyelid retraction is a term that describes an abnormally high position of the upper eyelids or unusually low position of the lower eyelids. Usually, the lids should rest just above or below the iris, the colored part of the eye.
Eyelid retraction may result from poor surgical healing, trauma, old age, and thyroid eye disease. The latter, also called Grave’s disease, is usually responsible for upper eyelid retraction, but may also cause lower lid retraction. Lower eyelid retraction is also a possible complication of cosmetic lower blepharoplasty. Genetics or some facial anatomy variants may also cause retraction of the lower eyelid, allowing too much sclera to show.
What Treatment Options Are Available for Eyelid Scarring and Retraction?
- Upper eyelid retraction surgery usually involves adjusting the levator muscle, which is the muscle primarily responsible for lifting the upper eyelid. Adjustment of this muscle allows the eyelid to close more completely over the ocular surface and hang at a more normal level when you are looking straight ahead. Depending on the cause of the upper eyelid retraction, it may be necessary to address scarring of the upper eyelid skin, which may require a skin graft.
- Lower eyelid retraction surgery may be a bit more involved, depending on the condition of the skin and the degree of retraction. Gravity works against us in this case, and if the lower eyelid closing muscle (orbicularis oculi muscle) is weak or loose, it may be necessary to use several techniques at once. Lower eyelid position also has an outsized influence on the movement of the tears as they lubricate the eye and flow toward the outflow ducts near the nose. When possible, surgery is limited to the tightening and lifting of the lower lids with adjustment of the tendons at the outer corners that hold the eyelids in normal position. However, in some situations, a midface lift, facial reanimation, or tissue grafting may be necessary to achieve the most desirable outcome.
Patients whose eyelid retraction is related to bulging eyeballs, most commonly associated with thyroid eye disease, may also benefit from orbital decompression. This technique is performed as part of the complete rehabilitation of patients who need it, and before eyelid surgery so that we can observe how the eyelids respond when the eyes’ protrusion is reduced.
Non-Surgical Alternatives for Eyelid Scarring and Retraction
Initially, treatment for eyelid scarring and retraction may center around controlling symptoms of eye exposure and dryness caused by poor ocular protection. Conventional approaches include eye drops, ointment, bandages, and other comfort measures.
While these strategies can help manage symptoms, they cannot correct the underlying eyelid position problem. When retraction is affecting eye protection, comfort, or appearance, surgery may be needed to more definitively correct the issue.
What is the Recovery Like From Eyelid Scarring & Retraction Treatment?
Corrective eyelid surgery may be conducted in an outpatient setting, so patients usually return home the day of their procedure. Commonly, pain is so minimal that patients feel close to normal the day after their surgery, except for typical swelling and bruising. Any discomfort that does occur can be managed with oral medication. Depending on the exact procedure, the eye may be covered with a bandage for a few days, partially closed temporarily, and patients should expect to avoid strenuous exercise for the first week or two. Most of the signs of recent surgery typically disappear within two weeks.
A post-operative follow-up is usually scheduled a week to ten days after surgery, at which point stitches will be removed. After this visit, many patients may be able to resume wearing makeup and contact lenses. More strenuous activity such as heavy lifting or intense aerobics can resume a few weeks after surgery.
Will Surgery for Eyelid Retraction Alter My Vision?
It is very rare for eyelid surgery to adversely affect vision. In most cases, vision improves after adjusting the eyelids.
Are There Risks With Eyelid Scarring and Retraction Treatment?
As with any eyelid surgery, treatment for eyelid scarring and retraction has potential risks. These may include swelling, bruising, bleeding, infection, scarring, asymmetry, dry eye symptoms, irritation, undercorrection, overcorrection, changes in eyelid position, difficulty closing the eye, or the need for additional surgery.
Risks vary depending on the cause of the retraction, prior surgery, scar tissue, thyroid eye disease, ocular surface health, and the type of repair performed. Our doctors will review the risks specific to your situation before surgery.
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