Could this be considered scleral show and lower eyelid retraction? Could it be related to my dry eye symptoms? (photo)

Yes it does appear you have lower eyelid retraction and may benefit from lower eyelid retraction surgery. Best to see an oculoplastic expert for evaluation and treatment.

Yes this is eyelid retraction. You have a larger space of exposed eye surface, so the tears evaporate more quickly leading to dry eyes. This usually gets worse with age as gravity pulls them down more.   We usually recommend surgery when symptoms progress to the point that they are affecting you on a daily basis and medical treatment has been exhausted. Hope this is a help and best of luck!

Thanks for your photos and question! In short, the photos do demonstrate scleral show as a result of lid retraction, which can have an impact on your dry eye symptoms. Eyes with retracted lower eyelid have greater surface area from which moisture can evaporate, and may also have lagophthalmos, a condition where the lids don't close fully or blink all the way. There are many things that can cause lid retraction, including thyroid issues, the eye being pushed forward, the eyelid being pulled down by scarring, and a lack of midface support (flat cheeks). By performing a detailed examination, an oculoplastic surgeon can assess what is causing your scleral show and explain treatment options that are most appropriate to your situation.

Thank you for your photos. Your scleral show indicates that you do have a problem with lower eyelid retraction or lower eyelid malposition. The right technique to correcting this will depend on the cause of the retraction and the amount of tissue laxity you have in the area. Your dry eye should improve with correction of this, but it may not resolve it completely. Hope this helps!Johnson C. Lee, MD Board-Certified Plastic Surgeon

Hello and thanks for the question! The tear production in our eyes comes from the lacrimal glands. The lacrimal glands are above the outer eyelid. The tears are produced laterally and they proceed across the eyeball every time you blink and finally drain into the tear ducts on the nasal end of the eyelid. For the tears to adequately lubricate the eyeball, the lids have to completely close. People with very prominent eyeballs, as opposed to patients with deep set eyes, are prone to having their eyelids open slightly as they sleep because it takes more eyelid to close the eye than if the eyes are more deep set. The muscles around the eye relax while we sleep and if the lid opens during sleep, the eyes can dry out. The lower lid retraction can occur congenitally as in your case or it can occur after lower eyelid blepharoplasty. When it occurs after eyelid surgery, it is usually due to a weakness of the muscles of the lower lid and can be repaired with a lid shortening technique. Your lid is obviously young and doesn't appear to have any laxity making a surgical repair much less likely. You will need to use your artificial tears during the day, protect the eye at night with Lacrilube ointment, and keep any air from drying you out such as a ceiling fan or air conditioner vent with a daytime sleeper mask. If the humidity is low, such as during cold weather when you turn the heater on, a humidifier will reduce the dryness. The diagnosis of scleral show due to congenital lower eyelid retraction appears to be correct. My Best!John Standefer MD