Are orbital rim implants required for solving scleral show?

Lower lid retraction can be treated in numerous ways depending on the cause. Most commonly in my practice, I treat lower lid retraction or scleral show with a lower lid spacer graft (hard palate or alloderm) and a canthoplasty. Orbital rim implants can certainly be used to help support the lower lid, especially if you have a negative vector (ie. the eye protrudes farther than your cheek bone). However, you need an in person consultation to determine the cause before a surgical plan can be made.

The role of adding structural support to the infraorbital rim-anterior malar area can be an important component of getting the best scleral show improvement/lower eyelid repositioning particularly in patients with a negative orbital vector. It really comes down to is there any underling orbital rim deficiency. Many cases of lateral lower lid sag and excessive scleral show do have an underling skeletal deficiency as the lower lid position usually follows the pattern of the bone shape underneath it.