Lid Retraction
A comprehensive overview of eyelid retraction, including causes, symptoms, diagnosis, treatment, and complications.
Eyelid Disorder
Thyroid Eye Disease
Acquired
Yes
Overview
Lid retraction is an abnormally elevated upper eyelid or abnormally lowered lower eyelid that exposes excessive sclera. It is most commonly associated with thyroid eye disease but may also result from trauma, surgery, neurologic disorders, or congenital abnormalities. Exposure of the ocular surface can lead to discomfort and vision-threatening complications.
Symptoms & Signs
- Wide-eyed appearance
- Scleral show
- Dry eye symptoms
- Foreign body sensation
- Photophobia
- Exposure keratopathy
- Lagophthalmos in severe cases
Common Causes
- Thyroid eye disease (Graves orbitopathy)
- Postoperative eyelid changes
- Trauma or scarring
- Facial nerve disorders
- Congenital abnormalities
- Orbital masses
Diagnosis
- Comprehensive eye examination
- External eyelid measurements (MRD1/MRD2)
- Slit-lamp examination
- Assessment for lagophthalmos
- Evaluation for thyroid eye disease and orbital pathology
Differential Diagnosis
| Condition | Distinguishing Feature |
|---|---|
| Thyroid eye disease | Most common underlying cause |
| Proptosis | Forward globe displacement |
| Lagophthalmos | Incomplete eyelid closure |
| Dermatochalasis | Excess eyelid skin |
Treatment
- Frequent ocular lubrication
- Manage underlying thyroid eye disease
- Moisture chamber or nighttime ointment
- Temporary botulinum toxin in selected patients
- Eyelid recession or reconstructive surgery when indicated
Complications
- Exposure keratopathy
- Persistent dry eye
- Corneal ulceration
- Vision loss in severe cases
Common ICD-10 Codes
| Code | Description |
|---|---|
| H02.531 | Lid retraction, right upper eyelid |
| H02.534 | Lid retraction, left upper eyelid |
| H02.532 | Lid retraction, right lower eyelid |
| H02.535 | Lid retraction, left lower eyelid |
Frequently Asked Questions
Is lid retraction always caused by thyroid disease?
No. Although thyroid eye disease is the most common cause, lid retraction may also occur after trauma, surgery, neurologic disorders, or congenital conditions.
Can lid retraction affect vision?
Yes. Significant ocular surface exposure can lead to corneal damage, ulceration, and vision loss if left untreated.
Medical Disclaimer
The information provided on Kardia Vision is for educational purposes only and should not replace professional medical advice, diagnosis, or treatment. Seek prompt evaluation for eyelid malposition, persistent eye irritation, or vision changes.