Eyelid retraction

Lid retraction has been an enigma for many generations of ophthalmologists. The differential diagnosis of lid retraction is both vast and complex. It is an entity encountered relatively infrequently in general ophthalmic practices. Graves’ ophthalmopathy is often the first diagnosis explored in a differential diagnosis for eyelid retraction. This common feature of Graves’ ophthalmopathy is certainly deserving of a workup for thyroid disease. Once thyroid disease has been ruled out, the differential diagnosis becomes much more diverse, and can be separated into neurogenic, myogenic, mechanistic, and miscellaneous causes using a classification scheme proposed by Bartley.Once the diagnosis has been made, planning for the treatment of the disease process may begin. Initial efforts should be directed at protecting the globe from exposure and corneal breakdown. After these complications have been addressed, the decision can be made whether to proceed with surgical intervention. Underlying disease processes should be controlled prior to the undertaking of surgical correction.