363 INTRODUCTION Lid retraction due to large cystic glaucoma fltration blebs is a rare entity. We present a case series of 5 patients, review the literature and discuss approaches to management. METHODS AND MATERIALS This study is a retrospective review of cases of lid retraction due to glaucoma fltering blebs. The study was conducted according to the principles of the Declaration of Helsinki. All of the following patients denied a history of thyroid disease, trauma, or previous eyelid surgery. Other causes of lid retraction were excluded on the basis of history, examination, blood investigations and, in certain cases, orbital imaging. In all patients, serum level of free T4, thyroid-stimulating hormone (TSH), thyroid receptor antibodies test were negative for thyroid disease. In all patients, the difference in palpebral fssure widths was maintained in downgaze. After manual down- ward distraction of the eyelid past the bleb, the lid reverted to its original position upon release. Where patients opted for surgical correction of their lid retraction, our choice of approach was a graded full thickness anterior blepharotomy. We modifed the technique by using adjustable sutures to fne-tune the fnal eyelid height as required on the ffth post-operative day. Case 1 A 64-year-old man with secondary traumatic glaucoma required glaucoma fltration surgery. He later developed a divergent squint that required correction on 2 occasions. The excessive conjunctival manipulation resulted in an exuberant bleb. He presented with signifcant right bleb dysesthesia with pain, dryness and irritation. Lid retraction and a large drainage bleb, extending 7mm posteriorly, was noted on the right. (Figure 1). A bleb compression suture and sub-conjunctival autologous blood injection was administered. This reduced the bleb size without compromising the IOP control. However, his dysesthesia symptoms and lid retraction persisted. Orbit, 28(6), 363–367, 2009 Copyright © 2009 Informa Healthcare USA, Inc. ISSN: 0167-6830 print/ 1744-5108 online DOI: 10.3109/01676830903180306 ORIGINAL ARTICLE Lid Retraction Following Glaucoma Filtering Surgery: A Case Series and Literature Review Manuel Saldana FRCOphth, Deepak Gupta MRCOphth, Mona Khandwala FRCS, and Bijan Beigi FRCOphth Norfolk and Norwich NHS Trust, Ophthalmology, Colney Lane, Norwich, nr4 7up United Kingdom ABSTRACT Purpose: To describe 5 cases of lid retraction associated with large cystic glaucoma fltering blebs. Methods: Retrospective case reports and literature review. Results: All 5 patients had lid retraction due to glaucoma fltering blebs. Two were successfully managed surgically by graded blepharotomy with resolution of lid retraction and bleb dysesthe- sia symptoms. Three patients were managed symptomatically. Conclusions: Lid retraction due to cystic glaucoma blebs is an unusual entity and a diagnosis of exclusion. The exact pathogenesis of the condition is unclear. Conservative, medical and surgical interventions exist to manage the lid retraction and any associated bleb dysesthesia. KEYWORDS: Lid retraction; bleb dysesthesia; glaucoma; fltering surgery Received 25 January 2009; revised 28 May 2009; accepted 12 July 2009 Correspondence: D. Gupta, Norfolk and Norwich NHS Trust, Ophthalmology, Colney Lane, Norwich, nr4 7up United Kingdom. E-mail: dgupta_01@yahoo.com