Do I have scleral show? Does it seem like something is wrong or I just have bigger eyes naturally? What are my options? (photo)

Question

I have white that is visible under the colored part of my eyes, and I have had two blood tests done to check for a thyroid problem (one last week and the other in 2016) and they both came back negative for a problem. I have always thought that I just had bigger eyes my whole life. I've never had surgery on my eyes before and not sure I ever want to. Does it seem like something is wrong or I just have bigger eyes naturally?

Mehryar (Ray) Taban, MD, FACS · Answer

Personal consultation is best to determine what should be done. You may benefit from upper eyelid ptosis surgery, lower eyelid retraction surgery and possibly bulging eye surgery. There are risks and limitations with each surgery.

Kenneth D. Steinsapir, MD · Answer

Your issue is upper eyelid ptosis. You have central levator aponeurosis disinsertion with a compensatory eyebrow elevation. You would benefit from surgery to repair the disinsertion and the ptosis. This generally also allows the brows to relax down to a more normal position. Be wary of the posterior approach mueller's muscle conjunctival resection. This surgery tends not to work in eyelids where the central levator no longer inserts into the upper eyelid tarsus.

Kenneth Hughes, MD · Answer

Thank you for submitting your photographs Based on the information you provided you would be a good candidate for lower eyelid surgery, however because the white part of your eye is larger on the bottom does not mean you have a condition. If still have reservations please consult with a Board-certified plastic surgeon for best results.Best of luck.

Inzhili Kitto, MD · Answer

Hello and thank you for your question. In general the lower eyelid sits 1-2 mm above the white part of the eye (corneal scleral junction). From the pictures it seems that your lower eyelid sits below that line. There is nothing wrong with that. It is more of a problem if it forms after an eyelid surgery. If this appearance still bothers you, you can benefit from lower eyelid surgery which can help tighten the lower eyelids and raise them so they sit at their proper position. You also appear to have droopy upper eyelids. If that obstructs your upper visual field, you can benefit from upper eyelid lift. 
I hope this helps and wish you all the best!
  
Inzhili Kitto, M.D.
  
Plastic Surgeon
  
Oculoplastic Surgeon

Jeffrey H. Lee, MD · Answer

Yes it does appear that your lower eyelid has some laxity that may be causing your scleral show.  This is the most likely diagnosis but it should really be confirmed by an in person consultation.  There are various reasons why someone can have scleral show so you have to be sure you are correcting the actual cause.  If it is laxity in your lower eyelid the procedure of choice would be a canthopexy vs canthoplasty.  Good luck!

Darab Hormozi, MD · Answer

Based on your photos, you have a slightly inferiorly placed lateral canthal tendon.  This is genetic and its not a sign of any diseases !  A lateral cantonal repositioning done by an expert oculoplastic surgeon with experience in these cases can easily correct this.  Make sure to find a surgeon who has done many of these as it can be tricky and not successful if it's not done correctly. Good luck.

Kevin Tehrani, MD, FACS · Answer

Thank you for your question and photos! It looks as though you have droopy lower eyelids, but this is genetic and doesn’t mean that anything is wrong! If you want it to be fixed, you could get a lower eyelid canthal repair under local anesthesia to help bring the lower eyelid up higher towards your iris. It’s a small surgery with a couple days of down time. I recommend consulting with a board certified plastic surgeon in person to discuss your concerns and learn more about the procedure.

Do I have scleral show? Does it seem like something is wrong or I just have bigger eyes naturally? What are my options? (photo)

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