Uneven eyes, iris showing completely in the left but in the right there is more sclera showing than the iris. How do I fix this?

Question

What's this called and what are my options to fix it?

Mehryar (Ray) Taban, MD, FACS · Answer

You have inherited lower eyelid retraction with sclera show.  You would likely benefit from Almond Eye Surgery which is combination of lower eyelid elevation + canthoplasty.  Canthoplasty alone will NOT fix the problem and can actually make it worse and distort your eye shape. See following link and video. There are 2 pages on my website you should visit: a) almond eye surgery, b) eyelid retraction surgery.

Kenneth D. Steinsapir, MD · Answer

Whatever you do, do not accept a simple lateral canthoplasty.  That surgery will not fix your issue. You have this issue due to the shape of the orbital rim. Simply tightening the lower eyelid, which is called a canthoplasty, is not likely to fix the issue.  The reason is that canthoplasty shortens the eyelid.  Rather than elevating the eyelid, the shorter lower eyelid is forced below the curvature of the eye, actually making the inferior scleral show worse.  There are a number of more complex options to raise the lower eyelid with grafts and rim implants.  The key is a careful assessment of your situation to determine what you need.

Harold J. Kaplan, MD · Answer

Hello, All good feedback from the panel members.However, before considering an invasive and more costly option, you may want to consider a small amount of Botox/Dysport just below the lower eyelid of the right eye to relax the lower lid to allow for more sclera showing.  If your goal is symmetry, then this is a much easier approach than surgery.  If you prefer the left eye, then a surgical option is the better choice.

Barry L. Eppley, MD, DMD · Answer

You have congenital lower eyelid retraction which really represents a deficiency of the tissues of the lower eyelid. A lateral canthoplasty alone will not lift up the horizontal level of the lower lids. Tissue grafts need to be placed on the inside of the lower eyelids to increase the vertical height of the lower eyelids.

Daniel Lensink, MD · Answer

Repair of lower lid retraction is a complicated undertaking. An oculoplastic surgeon could likely help you a great deal. Oculoplastic surgeons are eye surgeons ( ophthalmologists ) who undertake further training in plastic surgery of the area around the eyes.

Shoib Myint, DO, FAOCO · Answer

Hello xena13,
Your left lower lid is like a hammock attached to two trees (the bone near the nose and the bone near the outer corner of the eye), Imagine if the ropes of the hammock loosen. The hammock will drop. In essence that has happened to your left lower lid. The tendons (ropes) of your eyelids probably is involved along with other eyelid tissues to cause the drop. There are many reasons this could happen. Your outcome is a good one but the right surgery needs to be performed. A simple eyelid surgery may or may not be the answer. You might have some orbital component to this. Please seek out an expert oculoplastic surgeon to discuss your reasonable options.
Cheers

Uneven eyes, iris showing completely in the left but in the right there is more sclera showing than the iris. How do I fix this?

Answers (6)

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