Is there really a "normal" amount of schleral show? (photos)

Question

I had a lower bleph procedure done a couple of years ago to remove bags under my eyes. At the time, my eyes were a normal almond shape, and from pre-surgical photos it's easy to see that my iris was covered top and bottom (granted, more on top). I knew that my eye shape might change a bit, but I thought the results (image uploaded) was more than a "bit". I have discussed this with my surgeon ad nauseum, but he maintains that 2-3 mm of schleral show is completely normal. Is this true???

John Michael Thomassen, MD · Answer

It would be interesting to see before pictures as well and be able to compare these changes.  For scleral show to be noticeable, it should 2 mm or greater.  However, up to 10% of people without a history of surgery have scleral show to this degree.   If it is something that bothers you, you may benefit from a canthopexy to reduce the scleral show.

Thomas Fiala, MD, FACS, FRCSC · Answer

If this picture was taken in the standard straight-ahead gaze position, it shows excessive "white" (sclera) underneath the pigmented portion of your eye.  I prefer to see the lower lid covering that area.A canthopexy procedure may help you with this.  Best to see someone who has extensive experience in this area.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your picture.  Ideally, 2-3 mm of scleral show is not appropriate especially if you are symptomatic (tearing, eye irritation).  The best method to repair ectropion depends on the cause of the ectropion (scar, lax lower lid or decreased muscle tone).

Chris Thiagarajah, MD · Answer

Scleral show can be seen in patients normally but "normal" is a subjective term reflective of patient's anatomy and face. In short it is hard to say. If the inferior scleral show is bothering you or you have dry eyes it can be repaired with a spacer or retractor release but if it is a purely cosmetic issue, yours is on the fence to do anything in my opinion. I would get a second opinion from an oculoplastic surgeon who can judge your eye dryness as well.

Is there really a "normal" amount of schleral show? (photos)

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