Lower eyelid retraction and ectropion can occur as a result of prior eyelid surgery or injury (trauma).  When lower eyelid retraction is severe enough, the eyes become dry causing continuous eye irritation, tearing, decreased vision and even permanent scarring of the cornea. 

Lower eyelid retraction may occur after lower eyelid blepharoplasty.  There are three mechanisms that contribute to post-blepharoplasty lower eyelid retraction

• Excess removal of lower eyelid skin 
   
• Failure to address lower eyelid laxity (ectropion) 
   
• Excessive scarring of the middle lamella (orbital septum)

  

Normally, as the lower eyelid touches the eye, there should be no visible white (sclera) showing (red arrow). 

Patient After Lower Eyelid Blepharoplasty with Eyelid Retraction (Scleral Show)

 

 

With lower eyelid retraction, the eyelids may not completely close (lagophthalmos) at night cause symptoms of dry eye syndrome such as irritation, burning, tearing and vision loss. 

 

 

Same Patient with Lagophthalmos (eyelids open when sleeping)
 

Treatment of lower eyelid retraction is complicated and requires a thorough clinical examination to determine the causative factors as described above.  No one procedure is sufficient to treat lower eyelid retraction.  Dr. Korn utilizes a variety of techniques for revision eyelid retraction repair including:

• Cheek and mid facelifting - this repairs the excess lower eyelid skin removal (anterior lamella) 
   
• Spacer grafting - using hard palate (tissue from the roof of the mouth) or dermis fat (skin and fat from hip)
  
  
• Lower eyelid tightening - this corrects laxity that may have previously been present  

 

Using a combination of these techniques, we can restore the eyelids to their natural position as shown below.

 

This patient suffered from severe lower eyelid retraction and ocular irritation after lower eyelid blepharoplasty. Compared to before reconstructive surgery (left panel), there is dramatic improvement of normal eyelid position and good eyelid closure on the right panel.  

We have pioneered the use of dermis fat grafting for such cases of lower eyelid retraction and reported this study in the scientific literature.  Click Here to read full article.