Korean Journal of Ophthalmology 2008;22:255-258 ISSN : 1011-8942 DOI : 10.3341/kjo.2008.22.4.255 Upper Eyelid Retraction After Periorbital Trauma Soon Il Kwon, MD, Yun-Jeong Kim, MD Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Korea We report four unusual cases of upper eyelid retraction following periorbital trauma. Four previously healthy patients were evaluated for unilateral upper eyelid retraction following periorbital trauma. A 31-year-old man (Case 1) and a 24-year-old man (Case 2) presented with left upper eyelid retraction which developed after blow-out fractures, a 44-year-old woman (Case 3) presented with left upper eyelid retraction secondary to a periorbital contusion that occurred one week prior, and a 56-year-old man (Case 4) presented with left upper eyelid retraction that developed 1 month after a lower canalicular laceration was sustained during a traffic accident. The authors performed a thyroid function test and orbital computed tomography (CT) in all cases. Thyroid function was normal in all patients, CT showed an adhesion of the superior rectus muscle and superior oblique muscle in the first case and diffuse thickening of the superior rectus muscle and levator complex in the third case. CT showed no specific findings in the second or fourth cases. Upper eyelid retraction due to superior complex adhesion can be considered one of the complications of periorbital trauma. Korean J Ophthalmol 2008;22:255-258 ⓒ 2008 by the Korean Ophthalmological Society. Key Words: Eyelid retraction, Periorbital contusion Upper eyelid retraction is mainly caused by thyroid ophthalmopathy. Contributory factors include sympathetic overstimulation of Müller’s muscle, fibrosis, shortening, and overaction of the levator complex secondary to the tethering of the inferior rectus muscle.1,2 Other common causes of eyelid retraction include neurogenic disease and pseudoretraction of the eyelid,2 the latter of which is a result of contralateral blepharoptosis, and is frequently recognized in patients with acquired ptosis associated with levator aponeurosis dehiscence or disinsertion.3 Several reports have addressed upper eyelid retraction following a blow-out fracture and ocular surgery;4-7 however, we were unable to find a report on upper eyelid retraction following periorbital contusion without fracture. Here, we report on four cases of posttraumatic upper eyelid retraction with and without blow-out fracture. Case Repo rts Case 1. A 31-year-old man presented with left periorbital Received: April 12, 2008 Accepted: November 7, 2008 Reprint requests to Yun Jeong Kim, MD. Departement of Ophthal- mology Hallym University Sacred Heart Hospital. 896 Pyungchon-dong, Anyang-city, Gyeonggi-do 431-070, Korea. Tel: 82-31-380-3835, Fax: 82-31-380-3837, E-mail: bonamd@paran.com * This study was presented as a poster at the 96th annual meeting of the Korean Ophthalmological Society, November 2006. swelling and diplopia after a blunt orbital trauma (Fig. 1A). The man reported being hit by a lump of iron at work the previous day. The patient complained of diplopia in the primary position, left gaze, and downgaze. Hertel exophthalmometry measured 17 mm OU. Initial orbital computed tomography (CT) showed a large left inferior and medial orbital wall fracture extending posteriorly (Fig. 1C), and soft tissue was found to be entrapped at the orbital floor fracture site. The patient underwent surgical repair of the medial and inferior orbital fractures. Incarcerated soft tissue was released from the fracture site and a 26×16×1 mm sized Medpor barrier sheet implant (Porex Surgical Products Group, Newnan, GA, U.S.A.) was placed over the defect. One month after surgery, the diplopia disappeared in the primary position but remained in downgaze, especially during adduction. In addition, we detected newly developed left upper eyelid retraction and lid lag on downgaze (Fig. 1B). Hertel exophthalmometry measurement was the same as before surgery. An orbital CT scan revealed adhesion between the superior rectus and superior oblique muscle (Fig. 1D). The patient was followed for 10 months and the left upper eyelid retraction persisted without improvement. Case 2. This case was very similar to the first case, with the exception of the latent period. A 24-year-old man presented with left upper eyelid swelling and diplopia after falling down the previous day. He showed upper eyelid retraction and lid lag of the left eye (Fig. 2A, B). Orbital CT showed a large left medial wall blow-out fracture and no specific findings regarding extraocular muscles or orbital soft 255