What to do to improve the appearance of sclera?

Question

Hi, I just realized I have exposed sclera. I have no idea what to do and after some online research I am discovering how unattractive this feature is. What can I do to improve this appearance? I've already had tear trough filler (did that make it worse?) Please help :(. Also does cell phone usage make it more prominent?!

Douglas K. Henstrom, MD · Answer

Thank you for your questions.  First of all, no, cell phone usage did not contribute to this at all, so please don't worry about that.  Secondly, just because some people are saying scleral show isn't a wanted feature, doesn't mean that your eyes aren't attractive. Everyone will have some degree of scleral show in certain gaze directions-mainly when looking up. Your lower eyelids do look a little retracted, which may be contributing, but a full examination and evaluation is necessary to determine the degree of laxity and retraction, which then helps determine possible interventions. These are delicate surgeries that have the potential to make some aspects of the eye/eyelid complex worse if not done right.  Make sure you see someone who is credible and experienced and has your best outcome (even if that means telling you to do nothing) in mind.  Best of luck from Utah Facial Plastics.

A.J. Amadi, MD · Answer

This is often a hereditary feature in some patients, though certain diseases like Thyroid Eye Disease can also cause this. If you have always had this feature (which seems to be the case) then no need to worry about that, but if this a new feature, then you should be checked for Thyroid Hormone abnormalities and Thyroid Eye Disease. On the bright side, lower lid retraction repair is a common procedure that is performed by Oculofacial Plastic Surgeons (Oculoplastics) routinely. It is a delicate surgery that requires experience that General Plastic Surgeons rarely have. THere are many ASOPRS trained Oculoplastic surgeons in the NYC area, so you should have plenty of options. ASOPRS.org is a good source of information.

Mehryar (Ray) Taban, MD, FACS · Answer

It appears you have lower eyelid retraction. The only effective to change that is with lower eyelid retraction surgery. Best to have personal evaluation by expert to determine.

Chris Funderburk, MD · Answer

Thank you for the interesting questions and photos. First off, no, cell phone usage is assuredly not causing scleral show. I hope you didn’t read such on a medical site. Secondly, scleral show is not caused by cell phone usage. The exact positioning of your lower lids in relation to your iris will need to be determined during an in-person, physical exam before definitive recommendations can be provided. Lower eyelid surgery, especially that which alters the position of the lid, is a very delicate operation and the decision must not be taken lightly.

What to do to improve the appearance of sclera?

Answers (4)

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