Overview
Lower eyelid retraction occurs when the lower eyelid sits lower than normal, exposing more of the white of the eye below the iris. This changes the eye's appearance and can leave the surface of the eye dry and irritated because the lid no longer protects and lubricates it as well.
The problem often follows prior eyelid surgery, facial nerve weakness, scarring, thyroid eye disease, or age-related changes. Identifying the cause is important because it guides whether the lid needs support, tightening, or added tissue.
At Norelle Health, evaluation focuses on the position and tone of the lid, the health of the eye surface, and the underlying cause, so that treatment can restore protection and comfort while improving appearance.
Symptoms
People often notice that the eye looks more open or rounded, with more white showing below the iris. Dryness, irritation, tearing, and light sensitivity are common, and some have trouble fully closing the eye.
Symptoms may be worse in wind or dry environments and can fluctuate through the day.
Causes and risk factors
Common causes include prior lower-eyelid or cosmetic surgery that left the lid pulled down, facial nerve weakness, scarring after injury, thyroid eye disease, and age-related loosening of lid support.
Identifying the cause matters because scarring, weak support, and a shortage of tissue are treated differently.
Living with lower eyelid retraction? The next step is a quiet, unhurried conversation.
How it is diagnosed
Evaluation is based on an examination of lid position, tone, and laxity, along with the health of the eye surface. The clinician checks how the lid moves, whether it can be lifted into position, and whether the eye closes completely.
The assessment looks for an underlying cause, such as previous surgery, scarring, or thyroid eye disease, since this guides treatment.
Treatment options
Lubricating drops and ointment protect the eye surface and may be enough for mild retraction or while a plan is made. Treating an underlying cause, such as thyroid eye disease, is also important.
When the lid needs repositioning, surgical options include tightening the lid, adding a spacer graft to support and raise it, and repositioning the corner of the eyelid (canthal support). The technique is chosen based on the cause and the amount of tissue available, often in coordination with eye care specialists.
When to seek care
Seek evaluation for persistent dryness, irritation, tearing, or a sense that the lower eyelid is pulled down, particularly after eyelid surgery or facial nerve weakness. Prompt care is appropriate if the eye cannot close or the cornea becomes painful, since the eye surface needs protection.
Living with lower eyelid retraction? The next step is a quiet, unhurried conversation.
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Common Symptoms
Living with lower eyelid retraction? The next step is a quiet, unhurried conversation.
Treatment Approach
Treatment for lower eyelid retraction is individualized based on the severity of symptoms, anatomical considerations, and patient goals. Our specialists may consider:
- 01Lubricating drops and ointment to protect the eye surface
- 02Treatment of underlying causes such as thyroid eye disease
- 03Massage or scar management in selected cases
- 04Lower eyelid tightening procedures
- 05Spacer grafts to support and raise the lid
- 06Canthal repositioning to restore lid support
- 07Coordination with eye care specialists
Specialists who treat lower eyelid retraction
Dr. Moustafa Mourad
MD, FACS
Double Board-Certified Head & Neck and Facial Plastic & Reconstructive Surgeon
Dr. Moustafa Mourad is a double board-certified head and neck and facial plastic and reconstructive surgeon who cares for the full range of cosmetic and complex conditions affecting the face, head, and neck.
- Facial plastic and reconstructive surgery
- Head and neck cancer surgery
- Microvascular free-flap reconstruction
- Facial trauma and reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
Common causes include prior lower-eyelid surgery, facial nerve weakness, scarring after injury, thyroid eye disease, and age-related loosening of the lid. Identifying the cause guides treatment.
When the lower lid sits too low, it exposes more of the eye surface and spreads tears less effectively, which can leave the eye dry, gritty, and irritated.
Lubrication and treating an underlying cause can relieve symptoms in mild cases or while planning treatment. Restoring lid position usually requires a procedure when retraction is significant.
Surgical options include tightening the lid, adding a spacer graft to raise it, and repositioning the corner of the eyelid. The choice depends on the cause and the amount of tissue available.
It can be. Lower eyelid retraction is a recognized issue after some lower-eyelid or cosmetic procedures, often from scarring or reduced support, and it can frequently be improved with corrective surgery.
Ectropion is an outward turning of the lid margin, while retraction is a downward pull of the lid that exposes more of the eye. They can overlap, and evaluation distinguishes them to guide repair.
Lubricating drops during the day and ointment at night help protect the surface. If you cannot close the eye fully, seek evaluation so the cornea is protected.
Related Procedures
1 of 3 · Lower Eyelid Retraction Surgery
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