Purpose

To present a case of persistent upper eyelid retraction following Ahmed valve implantation performed 10 years earlier and to describe a stepwise surgical approach with intraoperative adjustment.

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Methods

A 51-year-old woman with long-standing upper eyelid retraction was evaluated. The condition began within the first three months after Ahmed valve implantation and remained stable thereafter. Clinical examination included measurement of MRD1, assessment of lagophthalmos, ocular surface status, and intraocular pressure.
Surgical correction was performed through an eyelid crease incision using a stepwise approach, including levator recession and additional procedures based on intraoperative findings, with progressive intraoperative adjustment of eyelid height.

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Results

Preoperatively, the patient presented marked eyelid elevation (MRD1: 8 mm), mild lagophthalmos, and signs of ocular surface exposure, with well-controlled intraocular pressure and no device-related complications.
Postoperatively, MRD1 decreased to 5 mm, achieving good eyelid symmetry, complete eyelid closure, and resolution of ocular surface exposure. The result remained stable during follow-up, with high functional and aesthetic satisfaction.

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Conclusion

Upper eyelid retraction following glaucoma drainage devices is an uncommon and likely multifactorial complication, potentially related to cicatricial changes and altered levator dynamics. It may represent a distinct entity compared to retraction after filtering surgery. A stepwise surgical approach with intraoperative adjustment allows individualized management and optimization of functional and aesthetic outcomes.

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Additional Authors

First name	Last name	Base Hospital / Institution
Elena	Arias García	Fundación de Oftalmología Médica de la Comunitat Valenciana
Rafael	Araújo Miranda Villaverde Lópes	Fundación de Oftalmología Médica de la Comunitat Valenciana

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