Scleral Show: What It Is & Why It Happens

Scleral show refers to the visible white part of the eye (sclera) showing below the iris when your eyes are open. Normally, the lower eyelid should gently touch the bottom of the iris. But if the eyelid is too low or retracted, the white sclera becomes visible.

It can happen naturally due to anatomy, or it can develop after cosmetic procedures such as lower eyelid surgery, aggressive blepharoplasty, fat removal, trauma, or aging.

In Korean plastic surgery clinics, scleral show is often discussed in relation to lower eyelid surgery, midface changes, and botched procedures.

What Scleral Show Looks Like

You may be experiencing scleral show if:

• You see white space under the iris when looking straight ahead
• The eyes look rounded instead of almond-shaped
• The lower eyelids feel pulled down
• The eyes appear dry, watery, or irritated
• You have a “sad” or “tired” look
• The lower eyelid position changed after a procedure

This creates an unbalanced look and can lead to discomfort.

Common Causes of Scleral Show

✔ 1. Aging (most common)

Weakening ligaments, skin laxity, and loss of volume cause the lower lid to descend.

✔ 2. Botched lower blepharoplasty

Too much fat or skin removed → eyelid retracts downward.

✔ 3. Lower eyelid retraction

Scarring, inflammation, or trauma pulls the eyelid down.

✔ 4. Midface descent

Cheeks drop with age and stop supporting the lower eyelid.

✔ 5. Thyroid eye disease

Causes eyelid retraction and bulging eyes.

✔ 6. Genetics / natural anatomy

Some people simply have lower lid laxity or round eye shape.

✔ 7. Overcorrected lower canthoplasty

Incorrect angle at the outer corner can create scleral show.

Why Scleral Show Matters

Scleral show is more than a cosmetic concern—it can affect eye comfort and function.

Possible symptoms:

• Dry eyes
• Excessive tearing
• Light sensitivity
• Burning sensation
• Irritation
• Difficulty closing fully

This is why many patients seek correction.

Treatment Options for Scleral Show

Treatment depends on the cause and severity. Here’s how it’s commonly fixed in Korea:

1. Lower Lid Tightening (Canthopexy / Canthoplasty)

Strengthens and lifts the lower eyelid.

Helps with:

• Loose lids
• Mild to moderate scleral show
• Downturned lower lid shape

2. Lower Lid Retractor Release

If the eyelid was pulled down after surgery, the surgeon releases the scar tissue or retractor muscles to restore position.

Best for:

• Post-surgery scleral show
• Retraction from scarring

3. Spacer Grafts (Cartilage Grafting)

Adds structural support to lift the lower lid.

Materials used:

• Ear cartilage
• Nasal cartilage
• Alloplastic materials

Best for:

• Moderate to severe scleral show
• Botched blepharoplasty
• Traumatic deformities

4. Midface Lift / SOOF Lift

Lifts the cheek fat pad to support the lower eyelid.

Best for:

• Aging-related scleral show
• Cheek descent
• Hollow under-eye area

5. Fat Grafting / Tear Trough Filler

Restores volume under the lower lid to soften the appearance.

Best for:

• Mild scleral show
• Hollow under-eyes
• Aging-related changes

(Not effective for severe cases.)

6. Non-Surgical Approaches

✔ Fillers

Can slightly raise the lower lid margin in mild cases.

✔ Energy devices (RF, ultrasound)

Tighten mild laxity but are not a cure for structural issues.

✔ Eye lubrication

Helps manage dryness until surgical correction.

Can Scleral Show Be Prevented?

Yes—especially during cosmetic procedures.

Preventive steps:

• Conservative fat removal during blepharoplasty
• Maintaining lower lid support
• Avoiding aggressive skin excision
• Selecting surgeons skilled in canthopexy
• Considering midface lift when needed

Korean surgeons usually combine techniques to avoid unnatural “round eyes” or downward-pulled eyelids.

Final Thoughts

Scleral show can dramatically alter the appearance of the eyes, making them look round, sad, tired, or unnatural. But with proper assessment, it can be successfully improved through lower lid tightening, grafts, fat restoration, or midface lifting.

Korea offers some of the most advanced correction techniques, especially for post-blepharoplasty complications.