Definition

Eyelid retraction is a condition characterized by the abnormal retraction or pulling of the eyelid. In this condition, the upper eyelid is pulled upwards, while the lower eyelid is pulled downwards. This retraction can occur in one or both eyelids and may affect only one eye.

Causes

Eyelid retraction can result from various causes, with the most common being eyelid injury and a history of eyelid surgery. Injuries and surgeries can cause chronic inflammation of the eyelid muscles, leading to muscle shortening or continuous contraction, resulting in contractures (stiffness). Additionally, surgery and injury can shorten the tissue between the skin and the conjunctiva (the clear membrane lining the sclera and the inside of the eyelid).

Beyond surgery and injury, eyelid retraction can also be caused by nerve and muscle-related diseases. Graves' disease, for example, involves the body's immune system attacking the muscles around the eyeball and eyelids, causing inflammation. Another condition associated with eyelid retraction is eyelid weakness due to nerve disorders, which can occur in the midbrain (Colliers' sign) or in the facial nerve as seen in Bell's palsy.

Eyelid retraction can also be related to abnormalities in the eyeball's shape, such as excessive length of the eyeball causing nearsightedness (myopia). It can be a congenital condition or result from prolonged skin inflammation like dermatitis. Eye infections such as trachoma, caused by the bacteria Chlamydia trachomatis, can also damage eyelid tissues.

Risk Factor

Risk factors for eyelid retraction are linked to skin damage. A history of atopy (allergies) such as atopic dermatitis (a skin disorder) increases the risk of eyelid retraction. Inflammatory skin conditions like rosacea (facial redness with acne-like spots) can also affect the eyelids. Other factors such as excessive ultraviolet light exposure, emotional stress, extreme weather conditions, spicy food, and alcohol consumption can exacerbate these conditions.

Symptoms

The primary symptom of eyelid retraction is the inability to close the eyes completely. Other signs indicative of the underlying cause include facial redness with acne-like spots, eyelid swelling, dry scaly skin, red eyes, and surgical or injury-related scars.

Diagnosis

Eyelid retraction can be visually identified, so an examination is necessary to determine its cause and potential complications. The doctor will inquire about the history of the condition, if it occurred recently or not, any previous eye infections (e.g., red eyes or swollen eyelids), history of atopy (allergies) such as childhood eczema, and any injuries, whether from blunt objects, sharp objects, or chemicals. The medical history will also cover previous surgeries, skin cancer, excessive sun exposure, and allergic reactions to specific medications.

The doctor will conduct a physical examination of the eyelids to identify which eyelid is retracted, and check for scars, swelling, thickening, and dry scales. Observations of the facial skin may provide clues about the cause of eyelid retraction. The strength of the eyelid muscles will be assessed by asking the patient to close their eyelids as tightly as possible.

Laboratory tests may be conducted if an underlying cause is suspected. For infections, a swab of the eyelid margin near the eyelashes may be taken and examined under a microscope or cultured. If a tumor is suspected, a tissue biopsy may be performed. In cases where Graves' disease is a concern, tests for TSH (thyroid stimulating hormone) levels and TSHR (TSH receptor) antibodies can be conducted.

Management

The treatment of eyelid retraction depends on the duration of the condition and its underlying cause. If the retraction has occurred recently due to chemical or thermal burns, irrigating the eyes with clean water or intravenous fluids can help neutralize the chemical or temperature. For dermatitis (eczema) causing retraction, avoiding dermatitis triggers is essential. In severe drug reactions like Stevens-Johnson Syndrome (SJS), identifying and discontinuing the causative drug is crucial. Antibiotics may be prescribed if an infection is suspected.

For dermatitis-induced eyelid retraction, a doctor may prescribe a steroid ointment to reduce skin inflammation. Since steroid ointments vary in strength and function, their use must be monitored to prevent side effects. If rosacea is the underlying cause, antibiotics may be prescribed.

If an autoimmune disease is suspected, a referral to a rheumatologist may be necessary. For cases where a tumor is the suspected cause, a referral to an oncologist (cancer specialist) will be made.

In cases of eyelid retraction due to Graves' disease, medications may be prescribed to reduce the autoimmune response, and Botox (botulinum toxin) injections may be used to relax the eyelid muscles.

Surgical intervention may be considered based on several factors, including the position of the retraction, the effectiveness of non-surgical therapies such as Botox injections, the duration of the retraction, and the patient's preference for invasive versus minimally invasive procedures.

Complications

Complications of eyelid retraction can arise from the condition itself or from the treatments administered. The inability of the eyelids to close completely can lead to dry eyes and an increased risk of injury from foreign objects, potentially causing watery eyes. Another complication is trichiasis, where the eyelashes grow inward toward the eye. Therapy-related complications may include glaucoma or cataracts from steroid use, or issues from surgical correction such as overcorrection or undercorrection.

Prevention

Preventing eyelid retraction due to injury involves using eye protection when engaging in risky activities, such as working with wood or metal. To prevent eyelid retraction caused by rosacea and dermatitis, it is important to avoid triggers, such as wearing sunglasses in bright sunlight and avoiding allergens.

When to See a Doctor?

Seek medical attention immediately if your eyelids cannot close completely, as this may indicate acute inflammation. Prolonged inability to close the eyelids can lead to complications like red and dry eyes. Since the eyelids play a crucial role in protecting the eyes and keeping them moist, untreated conditions can result in further complications.

Looking for more information about other diseases? Click here!