Upper eyelid retraction in long-standing anophthalmic sockets

Marked retraction of the upper eyelid is a rare but distressing complication of the anophthalmic socket. It usually occurs in long-term prosthesis wearers who have undergone enucleation in childhood or 20 to 30 years previously. Contributing factors include a large prosthesis, infrequent removal of the prosthesis, and lid closure difficulties. Clinically, the upper eyelid may be severely retracted, producing a wide-eyed stare as well as problems with comfort and prosthesis retention. The upper fornix may be foreshortened or of adequate depth but misdirected posteriorly. The postulated mechanism of anophthalmic upper eyelid retraction is a contraction of the levator muscle because of its role as an antagonist to the underutilized orbicularis muscle. Barring excessive atrophy of the lid layers, the eyelid can be brought forward out of the orbit to an acceptable position with surgical correction. Transcutaneous levator recession with interposition of eyebank sclera is the procedure used by the author.