The differential diagnosis and classification of eyelid retraction

Background: Classification schemes are useful in the formulation of differential diagnoses. Thoughtful commentary has been devoted to the classification of blepharoptosis, but the causes of eyelid retraction have received less attention in published reports. Although eyelid retraction most frequently is associated with Graves ophthalmopathy, numerous other entities may cause the sign. This study was undertaken to provide a more comprehensive differential diagnosis and classification of eyelid retraction. Methods: A series of patients with eyelid retraction was studied, and pertinent published reports were reviewed. Results: Forty-four patients with different causes for eyelid retraction are described. Normal thyroid function and regulation were confirmed in all patients in whom Graves ophthalmopathy could not be excluded by clinical, biochemical, or historical criteria. Conclusion: Based on a series of patients and reported cases, a differential diagnosis for eyelid retraction is proposed using a classification system comprising three categories (neurogenic, myogenic, and mechanistic).