Scleral show (visible sclera): what it is
Quick facts
- Definition
- Appearance of a white band of the eye (sclera) between the iris and the lower eyelid.
- Commonly cited causes
- Reduced cheekbone support, eyelid laxity, proptosis and anatomical variation.
- Relevance
- Gives a tired or 'sad' look and changes the assessment of the periorbital area.
- Caution in HOF
- Treating the periorbital area without assessing support can worsen the appearance.
- Management
- Careful assessment, in line with the rules of the professional's council in Brazil.
Scleral show, also called visible sclera, is the appearance of a white band of the eye, the sclera, between the lower edge of the iris and the lower eyelid. In a relaxed gaze, the lower eyelid usually touches or slightly covers the iris; when it sits lower, the white shows and the gaze takes on a tired look.
What are the commonly cited causes?
- Reduced support in the cheekbone area (malar hypoplasia), with the eyelid "dropping" downward.
- Laxity of the eyelid and of the lateral canthal tendon, which holds the outer corner.
- More prominent eyes or a shallow orbit.
- Changes after eyelid surgery or health events.
- Anatomical variation, with no other change.
The palpebral fissure and the tilt of the corner of the eye also influence the appearance.
Why does it matter in HOF?
When assessing the periorbital area, scleral show is a sign to pay attention to. Treating the tear trough or the palpebromalar groove without looking at cheekbone support and eyelid traction can accentuate the problem. In some patients, correcting the midface calls for assessment before any decision about the under-eye area.
What should you tell the patient?
The gaze is influenced by several structures. Explaining that the result of any adjustment is unpredictable avoids unrealistic expectations. If a medical cause is suspected, refer to an ophthalmologist.
In Harmy
The Tear Trough point lets you simulate the area in ml and intensity on the frontal photo. The projection is a visual conversation and does not predict the effect on eyelid position.
Also called: scleral show.
Frequently asked questions
Is scleral show a disease?
Not always. It can be a normal anatomical variation or related to age. In some cases it reflects a condition that needs assessment, and the referral is the professional's call.
Can midface filler help?
In some cases, supporting the cheekbone area changes the position of the lower eyelid, but the result is neither predictable nor guaranteed, and the indication depends on a full assessment.