What is scleral show after lower eyelid surgery?

How do you recognise scleral show?

With scleral show you see a white rim between the lower edge of the iris and the lower eyelid. Normally the eyelid sits neatly against the iris there, without any white of the eye visible below the iris.

It is most noticeable when looking straight ahead and can occur in one or both eyes. It can make the eyes look somewhat staring or tired, even when you feel well.

Sometimes it goes together with an eyelid that tilts slightly outwards. This is called ectropion and is a related malposition of the lower eyelid.

How does scleral show develop after lower eyelid surgery?

An important cause is removing too much skin during lower eyelid surgery, which pulls the eyelid down so it no longer stays at the right height.

Scarring or reduced support of the eyelid can also play a role. The eyelid may then not hold its position well enough, especially with a naturally lax eyelid, which is more common at an older age.

Swelling shortly after the procedure can cause temporary scleral show, which often settles during recovery. If it persists after the recovery period, there is usually a structural cause.

Is scleral show always permanent?

Not always. In the first weeks after lower eyelid surgery, mild scleral show due to swelling is fairly normal and part of the recovery process.

This often resolves once the swelling subsides and the tissue settles. So give the recovery enough time before drawing conclusions about the position of the eyelid.

If it persists after the recovery period, an assessment is wise to find out the cause. That makes it clear whether it will improve further on its own or whether something can be done about it.

What complaints can it cause?

Besides a change in appearance, scleral show can cause dry, stinging or, on the contrary, watery eyes, because the eyelid closes less well and the tear film evaporates faster.

Some people suffer from irritation or a burning sensation, especially in the wind or in the morning after sleeping. The eye can become more sensitive to external stimuli, such as draughts or dry air.

In mild cases the complaints are limited and can be well supported with eye drops. With more pronounced malpositions the complaints can be more bothersome and return daily.

How is scleral show treated?

The approach depends on the cause and severity. With mild complaints, support with eye drops and some time may be enough, especially if the swelling still has to subside.

If the eyelid has insufficient support, strengthening it with a canthopexy can help bring the eyelid back to the right height. This gives the eyelid margin more support.

With scarring that pulls the eyelid down, a targeted correction may be needed. With a clear malposition, an additional procedure is sometimes performed to reposition the eyelid.

How do you prevent scleral show?

Prevention starts with a conservative approach: better not to remove too much skin during lower eyelid surgery. A conservative approach considerably reduces the risk.

Assessing the firmness of the eyelid beforehand is important. If necessary, the eyelid is given extra support during the procedure, so it stays in place after the treatment.

A good assessment of muscle strength and skin quality helps keep the risk low. An approach from the inside of the eyelid, the transconjunctival approach, puts less strain on the eyelid margin.

When should you see a doctor?

Get in touch if the scleral show persists after the recovery period or if you continue to suffer from dry, irritated eyes. Persistent complaints are a good reason to seek advice.

An assessment is also wise if you are unsure about the position of your eyelid. Complaints that bother you every day, such as persistent irritation or a burning sensation, should be taken seriously.

A doctor can determine the cause and discuss with you whether and how a correction is possible. That way you know whether waiting is wise or whether an additional treatment may be worthwhile.

What is the difference between scleral show and ectropion?

Scleral show and ectropion are often mentioned in the same breath, but they are not the same. With scleral show the lower eyelid sits too low, so a strip of the white of the eye becomes visible below the iris.

With ectropion the edge of the lower eyelid tilts outwards, away from the eye. The eyelid then no longer lies neatly against the eyeball.

The two can occur together, but do not have to. Scleral show is sometimes mild and mainly cosmetic, while ectropion more often causes complaints because the eye is less well protected.

For the right approach it is important to know exactly what is going on. A doctor can make the distinction and decide on that basis whether treatment makes sense.

Have scleral show assessed at Kliniek het Bolwerk

Kliniek het Bolwerk specialises in the eye area and has extensive experience with the position and support of the eyelids. In situations like this, that experience matters.

During a consultation, Dr. David Jairath assesses the cause and discusses the options for your situation. You will then hear whether it is wise to wait for the recovery or to consider a correction.

That way you get clear and honest advice that suits your eyes. Do you have scleral show after lower eyelid surgery? Book an appointment for advice.