Eyelid retraction is an abnormally high position of the upper eyelid (or low position of the lower eyelid), showing the white of the eye above or below the iris. It gives a staring, fixed or startled look, and above all exposes the surface of the eye.
Causes
The leading cause is thyroid eye disease (Graves' disease), where it is often associated with exophthalmos. More rarely: the aftermath of ptosis or eyelid surgery, trauma, or a neurological cause.
The consequences
The over-exposed eye defends itself poorly: dry eye, gritty sensation, reflex watering, red eye, and in marked forms exposure keratitis. The aesthetic and social impact of the "staring look" is often the main concern.
Treatment
Protection of the ocular surface with lubricants in all cases. Eyelid lengthening surgery (recession of the retractor muscles, sometimes a spacer graft for the lower eyelid) durably corrects the eyelid position; in thyroid eye disease, it is only performed once the thyroid condition is stable. Botulinum toxin can provide temporary correction in the meantime.
Frequently asked questions
Should the thyroid be treated first?
Yes: thyroid balance and stabilisation of the orbitopathy (generally 6 months without progression) are prerequisites for retraction surgery, carried out in coordination with the endocrinologist.
Is the surgery covered by health insurance?
Yes when it corrects corneal exposure or retraction linked to a disease: it is functional, reconstructive surgery.
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