BACKGROUND--The challenge with the surgical repair of upper eyelid retraction is to obtain a more predictable and satisfactory postoperative eyelid contour and height, and to minimise the need for further surgery. METHODS--A retrospective analysis was performed on all patients treated surgically for eyelid retraction at Moorfields Eye Hospital over a 13 year period. RESULTS--In this study good postoperative results were obtained in 10 of 13 (77%) eyelids using adjustable sutures, compared with 56 of 148 (38%) eyelids using non-adjustable sutures (p < 0.01). With non-adjustable sutures, good results were achieved more often for non-thyroid compared with thyroid related eyelid retraction (26/55 versus 31/93 eyelids respectively, p < 0.05). Previous eyelid surgery did not affect outcome. CONCLUSION--We recommend the use of adjustable sutures for the repair of upper eyelid retraction, particularly in patients with thyroid disease.