Eyelid Retraction Repair

Eyelid retraction occurs when the eyelid is pulled abnormally high, exposing the white of the eye above or below the colored part, known as the iris. If you're experiencing difficulty closing your eyes or discomfort due to retracted eyelids, you're likely aware of the strain it can put on your eye health and appearance.

Restoring Comfort and Confidence

At New York Eye & Face, we understand the complexity of eyelid retraction and offer specialized repair surgery to address this issue. Our goal is to restore the functional aspect of your eyelids, allowing them to close properly and protect your eyes while also considering the aesthetic balance of your face. You’re in good hands with Dr. Anaïs Carniciu, M.D., a board-certified and ASOPRS-certified oculofacial plastic surgeon known for her exceptional skill and genuine compassion for her patients.

Eyelid Retraction Repair Before & After

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Causes of Eyelid Retraction

Thyroid Eye Disease

Thyroid eye disease is a complex condition that can significantly impact the eyes and surrounding structures. It is primarily associated with Graves' disease, an autoimmune disorder characterized by an overactive thyroid gland. However, thyroid eye disease can also occur in those with other thyroid disorders or even in the absence of thyroid dysfunction.

Here’s what you need to know:

The underlying mechanism of thyroid eye disease involves the immune system mistakenly attacking tissues around the eyes
This autoimmune response targets specific proteins within the orbital tissues, including muscles, fat, and connective tissue
The immune-mediated inflammation leads to swelling, scarring, and fibrosis in the affected tissues

One of the hallmark features of thyroid eye disease is eyelid retraction, where the upper and/or lower eyelids are positioned higher than usual. This can create a wide-eyed or staring appearance, often described as "lid lag" or "staring eyes." The retraction occurs due to the inflammation and scarring affecting the muscles and connective tissue that control eyelid movement.

Aftereffects of Skin Cancer

Skin cancer, especially when it affects the eyelids, may require surgical excision or other treatments that can alter the natural structure and elasticity of the eyelid tissues. As a result, the eyelids may become retracted, meaning they are positioned higher or lower than normal, leading to various complications such as:

Exposure Keratopathy: Eyelid retraction can expose the cornea to the environment, increasing the risk of dryness, irritation, and potential damage to the corneal surface. This condition is known as exposure keratopathy and can cause symptoms like redness, discomfort, and blurred vision.

Incomplete Blinking: Proper eyelid closure is essential for maintaining a healthy tear film and lubricating the eyes. Eyelid retraction can interfere with the blinking mechanism, leading to incomplete or inefficient blinking, which can contribute to dry eye syndrome and ocular surface problems.

Functional Impairments: In addition to cosmetic issues, eyelid retraction can result in functional impairments such as difficulty closing the eyes completely during sleep (nocturnal lagophthalmos) or problems with tear distribution and drainage.

Trauma

When the eye or its surrounding structures sustain physical trauma, such as burns, lacerations, or blunt force trauma, the body initiates a healing process to repair the damaged tissues. During this process, scar tissue forms as a natural part of wound healing. Scar tissue differs from normal tissue because it tends to be less elastic and more fibrous.

In cases where the trauma affects the eyelids or the tissues that support them, scar tissue formation can lead to eyelid retraction. The scar tissue contracts over time as it matures, exerting a pulling force on the surrounding structures, including the eyelids. This contraction and pulling effect can cause the eyelids to be pulled upward (upper eyelid retraction) or downward (lower eyelid retraction) from their normal position. The severity of eyelid retraction resulting from physical injury can vary depending on factors such as:

The extent of tissue damage
The location of the injury
Individual healing responses

Previous Surgery

An overly aggressive blepharoplasty refers to a surgical procedure aimed at improving the appearance of the eyelids by removing excess skin, fat, or muscle. While blepharoplasty can yield desirable outcomes when performed judiciously and with careful attention to anatomical details, complications such as eyelid retraction may arise if the surgery is overly aggressive or the delicate balance of eyelid structures is disrupted.

Common causes of eyelid retraction complications from previous surgeries include the following:

Excessive Tissue Removal: In some cases, excessive skin, muscle, or fat removal during blepharoplasty can lead to tension and tightness in the eyelids, causing them to retract or pull away from the eye.

Inadequate Support: The support structures of the eyelids, including the tarsal plate (the firm tissue that gives the eyelids their shape) and the eyelid retractors (muscles responsible for eyelid elevation and closure), may be weakened or disrupted during surgery. This can contribute to eyelid retraction and instability.

Scar Formation: Scar tissue formation following surgery can alter the normal elasticity and mobility of the eyelids. Scar contracture or adhesions may cause the eyelids to become retracted, rigid, or immobile, leading to functional limitations and cosmetic concerns.

Benefits of Eyelid Retraction Repair

Your cornea will be better protected after the retraction is repaired, which reduces the risk of dryness and injury
Your eyes are less likely to suffer from irritation and discomfort caused by overexposure
The sensation of a foreign body in the eye can often be eased after the surgery
Visual disturbances that may have been caused by eyelid positioning can be corrected
The surgery can yield a rejuvenated appearance as the eyelids will look more natural and symmetric
Post-repair, your facial expressions and eye contact may appear more relaxed and engaging

How is Eyelid Retraction Diagnosed?

When suspecting eyelid retraction, Dr. Carniciu will start with a comprehensive oculoplastic exam. During this exam, you may expect the following:

Dr. Carniciu will carefully observe the position of your eyelids when your eyes are open and closed
The margin-reflex distance (MRD) is measured, which assesses the distance from the light reflex on the cornea to the eyelid margin
A discussion of your ocular history to determine any underlying causes
A closer inspection using specialized equipment to evaluate the eye's structures and your eyelid position and function
An eyelid tension test checking for tightness in the eyelid retractors
Blood tests to look for markers of autoimmune diseases, particularly thyroid function tests, if Graves' disease is a concern
CT or MRI if a tumor or other orbital pathology is possible

Am I a Good Candidate for Eyelid Retraction Repair?

Here are the critical candidacy factors considered in eyelid retraction repair:

Severity of Retraction: The extent of eyelid retraction is essential when evaluating a patient's suitability for surgery. Patients with moderate to severe retraction, whose eyelids are noticeably out of place and lead to issues like incomplete blinking or exposure keratopathy, are often good candidates for surgical correction.
Functional Impairments: Patients with dry eyes, irritation, feeling like something is in their eye, blurred vision or difficulty fully closing their eyes during sleep (nocturnal lagophthalmos) due to eyelid retraction are likely to find relief through surgery.
Cosmetic Concerns: Many worry about looking wide-eyed or startled because of retracted eyelids. If the cosmetic aspect of retraction bothers someone, especially if it affects their self-esteem and confidence, they may choose surgery to fix it.
Underlying Causes: Retraction caused by previous surgeries, trauma, thyroid eye disease, or congenital conditions may require different surgical approaches and considerations based on the specific etiology.

Surgical Techniques for Eyelid Retraction Repair

Lateral Tarsal Strip Procedure

The Lateral Tarsal Strip Procedure tightens the lower eyelid. Dr. Carniciu makes an incision at the outer corner of your eye, removes a small section of the eyelid's lateral tissue, and then sutures it right to the bony lining of the orbital bone. This procedure is often recommended when horizontal eyelid laxity contributes to low-hanging bottom eyelids.

Levator Recession

In Levator Recession, the levator muscle, responsible for lifting the eyelid, is weakened. Dr. Carniciu will make an incision on the inside of the upper eyelid to access the levator muscle and then recess it, which involves repositioning the muscle further back on the eyelid. This allows for more controlled eyelid movement.

Grafting Procedures

Grafting procedures involve adding tissue to the eyelid to lengthen it. You might receive a graft of skin, mucous membrane, or hard palate tissue, which will be sewn into the eyelid. This technique is used when a tissue shortage occurs due to scarring or severe retraction.

Midface Lift

A midface lift is a more extensive procedure that addresses lower eyelid retraction by lifting the cheek and midface tissues. Dr. Carniciu will reposition these tissues to support the lower eyelid and improve eyelid closure. This is often considered when lower eyelid retraction is accompanied by sagging, droopy skin in the midface.

Recovery and Results

Post-surgery, you must keep the surgical site clean and dry. Typically, you will use prescribed eye drops or ointments and apply ice to the area. Avoid putting pressure on the eyes when washing the face.

Follow-up appointments are critical to assess the healing process. You should expect to see Dr. Carniciu for post-operative checks one week, one month, and three months after surgery, but the schedule may vary based on individual circumstances.

Eyelid retraction repair has a high success rate. Most patients experience improved symptoms such as eye discomfort and exposure symptoms post-recovery. The complete healing process can take several weeks to months, and final outcomes should be evaluated after this period.

Why Choose New York Eye & Face for Eyelid Retraction Repair?

Choosing a specialized facility for eyelid retraction repair is crucial for the safety and success of your treatment. New York Eye & Face is led by Dr. Anaïs Carniciu, M.D., an accomplished oculoplastic surgeon who focuses on your unique needs with precision and care. Expertise is paramount in delicate procedures like these, and our facility boasts a team of highly trained professionals with extensive experience.

At New York Eye & Face, we use the latest technology to ensure all procedures are done with the most advanced and effective equipment. Your comfort and results are our top priorities. We recognize that each patient has a unique story and specific concerns that require a personalized approach. Dr. Carniciu and our team are committed to ensuring you are fully informed and comfortable at every stage of your healing journey. To take the first step towards your eyelid retraction repair with elevated care and results, book a consultation with Dr. Anaïs Carniciu, M.D.