To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction.

Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated.

Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean ± standard deviation of 27.7 ± 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 ± 1.3 mm from 6.3 ± 1.5 mm preoperatively to 3.2 ± 0.9 mm postoperatively ( p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly ( p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession.

Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.