Lid Retraction

Lid Retraction

Lid retraction is present if a band of sclera is visible between the upper eyelid and the corneal limbus in the primary position (cf. lid lag). This should be distinguished from contralateral ptosis. Recognized causes of lid retraction include:

  1. Overactivity of levator palpebrae superioris: Dorsal mesencephalic lesion (Collier’s sign)

Opposite to unilateral ptosis, e.g., in myasthenia gravis; retracted lid may fall when ptotic lid raised; frontalis overactivity usually evident
Paradoxical lid retraction with jaw movement (jaw winking, Marcus Gunn phenomenon)

  1. Overactivity of Müller’s muscle:

irritative oculosympathetic lesions (Claude-Bernard syndrome)

  1. Contracture of the levator muscle:

Hyperthyroidism, Graves’ ophthalmopathy (Dalrymple’s sign): may be associated lid lag
Myotonic syndromes
Aberrant oculomotor (III) nerve regeneration (pseudo-von Graefe’s sign)

  1. Cicatricial retraction of the lid, e.g., following trauma
  2. Hepatic disease (Summerskill’s sign)
  3. Guillain-Barré syndrome.

Lower lid retraction may be congenital, or a sign of proptosis. Ectropion may also be seen with lower lid tumor or chalazion, trauma with scarring, and ageing.


Cross References

Collier’s sign; Contracture; Dalrymple’s sign; Jaw winking; Lid lag; Proptosis; Pseudo-Von Graefe’s sign; Ptosis; Stellwag’s sign; Setting sun sign