Upper eyelid retraction after retinal detachment repair

Two patients with high myopia developed unilateral upper eyelid retraction after retinal detachment surgery with superiorly placed scleral buckles and 360-degree encircling elements. The isolated upper eyelid retraction was stable for 16 and 23 years, respectively. Other common causes of eyelid retraction, including cicatricial processes such as thyroid-related orbitopathy, neurogenic disease, and pseudoretraction of the eyelid, were excluded in both patients. The first patient had no evidence of proptosis or lid lag on downgaze but had exposure keratitis that required recession of Müller's muscle and conjunctiva. The second patient had lid lag on downgaze, and orbital computed tomography demonstrated an enlarged eye with an encircling element that caused mild pseudoproptosis. This patient required no treatment. The unilateral upper eyelid retraction did not progress in either patient. Although the exact mechanism of the upper eyelid retraction in these two cases is unclear, previous retinal surgery that involves superiorly placed implants must be considered in the differential diagnosis of unilateral upper eyelid retraction, especially when the patient has a history of pathologic myopia.