The anatomical distance from the upper lid margin to the eyelid crease is measured with the patient looking down (Figure 5.2). There
may be more than one skin crease but generally there is a dominant one which becomes apparent when the patient moves their lid. Excess upper lid skin may overhang the skin crease and should be gently lifted out of the way, without stretching the skin, to enable the skin crease to be measured.
In the primary position, the distance from the lid margin to the edge of the overhanging upper lid skin is known as the pretarsal show and is an important cosmetic aspect. It is affected both by the skin crease position and the lid position.
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