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Chung, Shin, and Lew: Nonsurgical Treatment of Abnormal Eyelid Position Using Hyaluronic Acid Gel
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(3): 357-364.

Published online: 15 March 2012

DOI: https://doi.org/10.3341/jkos.2012.53.3.357

Nonsurgical Treatment of Abnormal Eyelid Position Using Hyaluronic Acid Gel

Seok Joong Chung, MD, Hyun Min Shin, MD, Helen Lew, MD

Department of Ophthalmology, Bundang CHA General Hospital, CHA University, Seongnam, Korea.

Address reprint requests to Helen Lew, MD. Department of Ophthalmology, Bundang CHA General Hospital, CHA University, #59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea. Tel: 82-31-780-5330, Fax: 82-31-780-5333, eye@cha.ac.kr

Received 13 January 2011       Accepted 17 February 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

The present study investigated the outcomes of nonsurgical treatment of abnormal eyelid position using hyaluronic acid gel.

Methods

Abnormal eyelid position including 18 eyes with lid retraction, 10 eyes with lagophthalmos, and 18 eyes with ectropion were treated with hyaluronic acid gel. The mean age was 50 ± 17.8 years and the mean observation period was 11 ± 2.4 months. The photographs of patients were taken before injection, 1 month, 4 months, and at the last follow-up after injection. The marginal reflex distance 1 (MRD1) and marginal reflex distance 2 (MRD2) of patients were measured and analyzed by the Image J Program. The severity of ectropion was graded by a scoring system.

Results

Ten eyes with lagopthalmos improved 1.9 ± 1.2 mm after injection. The 16 eyes with lid retraction improved 1.3 ± 0.9 mm. Twenty-three eyes with ectropion improved and 17 eyes (81%) were completely corrected. The average frequency of injection was 1.1 and the average dose of injection was 0.4 ± 0.12 cc. No significant complications were observed in any patient.

Conclusions

Hyaluronic acid gel injections can be used safely and effectively as a nonsurgical treatment for patients with abnormal eyelid position without any significant complications.

Keywords: Ectropion, Hyaluronic acid gel, Lagopthalmos, Lid retraction, Nonsurgical treatment

Figures and Tables

Figure 1
Schematic image of locations of hyaluronic acid gel injection. (A) Image of upper lid. (B) Image of lower lid.
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Figure 2
Examples of patients with lagopthalmos, before and after treatment with hyaluronic acid. Case 2, 81 year-old female with left lagopthalmos. (A) Before injection, (B) 4 months after injection. Case 3, 50 year-old female, with left paralytic lagopthalmos (C, D). Case 4, 39 year-old female, with right lagopthalmos. (E) Before injection, (F) 6 months after injection.
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Figure 3
Examples of patients with lid retraction, before and after treatment with hyaluronic acid gel injection. Case 2, 15 year-old female, after primary closure of lowerlid laceration. (A) Before injection, (B) 5 months after injection. Case 7, 58 year-old female, after Lower lid blepharoplasty who has injury of facial laceration. (C) Before injection, (D) 6 months after injection. Case 8, 11 year-old female, with lid retraction. (E) Before injection, (F) 6 months after injection.
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Figure 4
Examples of patients with ectropion, before and after treatment with hyaluronic acid. Case 3, 45 year-old male, with left paralytic ectropion. (A) Before injection, (B) 5 months after injection. Case 5, 72 year-old female, with left facial palsy. (C) Before injection, (D) 3 months after injection. Case 12, 70 year-old male, after lower blepharoplasty. (E) Before injection, (F) 8 months after injection.
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Table 1
Demography of the patients with lagophthalmos
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Table 2
Demography of patients with lid retraction
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IPF = interpalpebral fissure; ULLL = upperlid lowerlid; LL = lowerlid; UL = upperlid; s/p = post operative status.

Table 3
Demography of patients with ectropion
jkos-53-357-i003

ULLL = upperlid lowerlid; LL = lowerlid; UL = upperlid.

*Surgeon's grading system- Excellent: improvement of whole eyelid, Good: correction with improvement more than half of eyelid, Poor: correction with improvement less than half of eyelid; †Patient's grading system- Execllent: satisfaction of both cosmesis and symptoms, Good: satisfaction of comesis or symptoms, Poor: satisfaction of cosmesis nor symptoms.

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