THE DIFFERENTIAL-DIAGNOSIS AND CLASSIFICATION OF EYELID RETRACTION

Background: Classification schemes are useful in the formulation of di fferential diagnoses. Thoughtful commentary has been devoted to the cl assification of blepharoptosis, but the causes of eyelid retraction ha ve received less attention in published reports. Although eyelid retra ction most frequently is associated with Graves ophthalmopathy, numero us other entities may cause the sign. This study was undertaken to pro vide a more comprehensive differential diagnosis and classification of eyelid retraction. Methods: A series of patients with eyelid retracti on 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 al l patients in whom Graves ophthalmopathy could not be excluded by clin ical, biochemical, or historical criteria. Conclusion: Based on a seri es of patients and reported cases, a differential diagnosis for eyelid retraction is proposed using a classification system comprising three categories (neurogenic, myogenic, and mechanistic).