Korean J Ophthalmol Vol.22, No.4, 2008 Fig. 1. Case 1: (A) At his visit he showed mild swelling and bruising in the left eyelid, but no retraction was noted. (B) Left upper eyelid retraction developed one month after blow-out fracture repair. (C) CT scan showing a large left medial and inferior wall fracture and soft tissue incarceration. (D) One month after blow-out fracture repair, this CT scan revealed adhesion between the superior rectus and superior oblique muscles (arrow). tissue (Fig. 2C). Ancillary tests were within normal limits. The patient underwent blow-out fracture repair with a porous implant. The surgical outcome was satisfactory without any ocular motility disorder except left upper eyelid retraction that developed at the time of trauma (Fig. 2D). The patient strongly denied preexisting upper eyelid retraction and refused a secondary orbital CT, therefore we could not pursue further evaluation of other possible causes of the eyelid retraction. Case 3. A 44-year-old woman presented with left upper eyelid retraction following periorbital contusion one week prior to initial presentation. Upon examination we noted upper eyelid retraction with a 1 mm scleral show and a lid lag of her left eye (Fig. 3A, B). Hertel exophthalmometry showed no difference between the right and left eyes. Thyroid function testing was performed to exclude thyroid ophthalmopathy, and an orbital CT scan was performed. The thyroid function test included T3, T4, free T4, TSH, TSH Fig. 2. Case 2: (A) At his visit he showed swelling, bruising and retraction in the left eyelid. (B) Significant lid lag on downgaze in the left eye. (C, D) Eyelid retraction and lid lag persisted in the left eye one month after blow-out fracture repair. receptor antibodies, and antithyroglobulin antibodies. The laboratory results were normal and CT showed mild and diffuse thickening between the left superior rectus muscle and the levator complex (Fig. 3C). She was followed for 6 months without improvement of the left upper eyelid retraction. Case 4. A 56-year-old man visited our clinic for a left orbital contusion and lower canalicular laceration sustained in a traffic accident. His initial orbital CT scan revealed no specific findings, so the following day we repaired the canalicular laceration and inserted a Crawford tube. However, one month after surgery, even though the sutured wound was in good condition, he presented with upper eyelid retraction and a slight lid lag on the left eye (Fig. 4A, B). Routine laboratory tests, including a thyroid function test, were normal. A second orbital CT scan with enhancement was performed, but no noticeable findings resulted, unlike in cases 1 and 3 (Fig. 4C). The patient was not overly concerned about the asymmetry of his upper eyelid. He was followed for 3 months and did not return for subsequent follow-up. Fig. 3. Case 3: (A) Left upper eyelid retraction with a 1 mm scleral show. (B) Significant lid lag on downgaze. (C) Contrast-enhanced CT scan showing mild and diffuse thickening between the superior rectus muscle and levator complex. 256