Congenital, paradoxical lower eyelid retraction on upgaze

Purpose: Active lower eyelid retraction on upgaze is a rarely described fin ding. The purpose of this study is to describe the clinical and operative f indings in two patients with this unique eyelid movement disorder. Methods: The authors identified active, unilateral lower eyelid retraction on upgaze in two patients who had no other ocular or systemic abnormalities . Results: Surgical extirpation of the lower eyelid retractor complex was car ried out in both cases. During one of the procedures, performed under local anesthesia, the lower eyelid retractors were observed to retract actively on upgaze. Postoperatively, lower eyelid retraction on upgaze was not prese nt in either case. Conclusions: The authors are aware of only one other case report describing active, paradoxical lower eyelid retraction on upgaze. The mechanism of ey elid retraction in this previous report and in the two patients described h erein is not known. The authors postulate that these unique cases may repre sent a previously unrecognized form of congenital, aberrant innervation of the oculomotor nerve.