Upper eyelid retraction following deep sclerectomy: A case report

Abstract: Upper eyelid retraction is an uncommon finding, most frequently associated with thyroid eye disease or mechanical factors. While cases have been reported after trabeculectomy, no such occurrence has been documented following deep sclerectomy. We describe a 32-year-old woman who developed persistent left upper eyelid retraction shortly after deep sclerectomy for glaucoma. Clinical evaluation revealed a stable retraction of 7 mm margin reflex distance 1, with normal levator function, no proptosis, and an avascular, low-lying bleb. Thyroid function tests and orbital magnetic resonance imaging were unremarkable, excluding thyroid orbitopathy and structural causes. Histopathology of Müller’s muscle was normal, whereas conjunctival specimens showed chronic inflammation without fibrosis. These findings support a functional mechanism, likely related to bleb-induced conjunctival inflammation affecting Müller’s muscle activity. Transconjunctival müllerectomy successfully restored lid height to symmetry with the fellow eye, without compromising bleb function. To our knowledge, this is the first reported case of eyelid retraction following deep sclerectomy, expanding the spectrum of bleb-related complications.