Natural Causes for Scleral Show

While it is true that people with strong cheek bones have excellent support for the lower eyelid and tend to hold their lower eyelids well as they age, the opposite can be true for people with weak cheek bone support.  Large eyes, relatively flat cheeks, or heavy cheek pads are associated with gradual inferior scleral show.  Generally these changes are acceptable cosmetically and in some cases the large eyed look associated with a little inferior scleral show is often considered a desirable feature.

Some people are born with scleral show and it just how their eyelids developed. If you do not have scleral show now, you probably will not have it in your lifetime unless it has been surgically created or is due to trauma.

Scleral show refers to the ability to see the white portion of the eye below the colored portion (Iris). And most people one you look straight ahead the lower eyelid covers the eyeball up to the base of the Iris. Any condition which creates laxity or limits motion of the lower eyelids can contribute to scleral.This could include a number of congenital anomalies known as craniofacial defects, it could be related to trauma where the facial bones had been fractured and subsequent healing and scar tissue formation limits movement or the lower lid is not positioned properly.

It occurs with aging as the lower lid loses its muscle tone and the skin becomes more elastic. It also can occur with someone having lost soft tissue volume in their cheeks. I have patients who have a history of allergies with a lot of swelling in their eyelids and they develop this problem. The other problem could be that the eyeball itself is prominent and pushes the lower lid out of the way, which is something we see with problems such as hyperthyroidism.

There are many natural reasons for scleral show. It would be unlikely to occur at the very young age of 23 but does cause problems for people who are 50+ and requires surgery in some cases.

The main reason for the scleral show without history of trauma surgery,is weak bony support of the eye. The loss of the elasticity is another reason for the scleral show.

Scleral show, the unveiling of the "white" of the lower eye by a dropping eyelid is USUALLY caused by an interaction of increased lower lid laxity, decreasing lower lid support (which may be natural in people with under developed cheek bones) and increasing pull on the lower lid by a sagging cheek. It is a natural consequence of aging.

A very extreme manifestation of scleral show is Ectropion (look it up on Google pictures) in which the lower lid no longer touches the eyeball resulting in tearing, redness and worse. this needs to be corrected surgically.