Use of hyaluronic acid gel in the management of paralytic lagophthalmos: The hyaluronic acid gel "gold weight"

Ronald Mancini, Mehryar Taban, Alan Lowinger, Tanuj Nakra, Angelo Tsirbas, Raymond S. Douglas, Norman Shorr, Robert A. Goldberg

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the safety and efficacy of injecting hyaluronic acid gel in the upper eyelid as a nonsurgical alternative in the treatment of paralytic lagophthalmos. Methods: This is a retrospective study of 9 patients (10 eyelids) with paralytic lagophthalmos treated with hyaluronic acid gel in the prelevator aponeurosis region and/or pretarsal region of the paralytic upper eyelid. Pretreatment, posttreatment, and follow-up photographs were digitized, and overall outcomes assessed. Measurements of lagophthalmos were standardized and compared. Slit-lamp examination was used to evaluate the degree of exposure keratopathy. ImageJ was used for photographic analysis. Results: Ten eyelids (9 patients, 7 men; mean age 69.2 years; range, 31-90 years) with paralytic lagophthalmos were treated with hyaluronic acid gel. The average amount of injected hyaluronic acid gel was 0.9 ml (range, 0.2-1.2 ml). All patients demonstrated significant improvement in lagophthalmos and exposure keratopathy. The mean improvement in lagophthalmos was 4.8 mm (range, 0.9-11.9 mm; p = 0.001). Of the 5 patients with follow-up, the mean follow-up period was 3.6 months (range, 2-5 months). Of these, 2 had no change in lagophthalmos (both maintained 0 mm at 5 months), one had a slight decrease in lagophthalmos (4.8-4.6 mm at 2 months), one had a slight increase in lagophthalmos (0.3- 0.5 mm at 2 months), and one had a more significant increase in lagophthalmos (1.9-4.3 mm at 4 months). The latter patient underwent a second treatment with further reduction of lagophthalmos to 0.4 mm. Overall, there was a decrease in margin reflex distance from the upper eyelid margin to the corneal light reflex (MRD1) but it was not statistically significant. Complications were minor and included transient ecchymosis, edema, and tenderness at the injection sites. Conclusions: On the basis of these preliminary results, hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of paralytic lagophthalmos. This treatment may be particularly useful in patients who are poor surgical candidates and/or as a temporizing measure in patients in whom return of facial nerve function is anticipated, given the hyaluronic acid gel's properties of slow resorption and reversibility with hyaluronidase.

Original languageEnglish (US)
Pages (from-to)23-26
Number of pages4
JournalOphthalmic Plastic and Reconstructive Surgery
Volume25
Issue number1
DOIs
StatePublished - Jan 2009

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Hyaluronic Acid
Gold
Eyelids
Gels
Weights and Measures
Ecchymosis
Blinking
Hyaluronoglucosaminidase
Facial Nerve
Therapeutics
Reflex
Edema
Retrospective Studies
Safety
Light
Injections

ASJC Scopus subject areas

  • Ophthalmology
  • Surgery

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Use of hyaluronic acid gel in the management of paralytic lagophthalmos : The hyaluronic acid gel "gold weight". / Mancini, Ronald; Taban, Mehryar; Lowinger, Alan; Nakra, Tanuj; Tsirbas, Angelo; Douglas, Raymond S.; Shorr, Norman; Goldberg, Robert A.

In: Ophthalmic Plastic and Reconstructive Surgery, Vol. 25, No. 1, 01.2009, p. 23-26.

Research output: Contribution to journalArticle

Mancini, Ronald ; Taban, Mehryar ; Lowinger, Alan ; Nakra, Tanuj ; Tsirbas, Angelo ; Douglas, Raymond S. ; Shorr, Norman ; Goldberg, Robert A. / Use of hyaluronic acid gel in the management of paralytic lagophthalmos : The hyaluronic acid gel "gold weight". In: Ophthalmic Plastic and Reconstructive Surgery. 2009 ; Vol. 25, No. 1. pp. 23-26.
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N2 - Purpose: To evaluate the safety and efficacy of injecting hyaluronic acid gel in the upper eyelid as a nonsurgical alternative in the treatment of paralytic lagophthalmos. Methods: This is a retrospective study of 9 patients (10 eyelids) with paralytic lagophthalmos treated with hyaluronic acid gel in the prelevator aponeurosis region and/or pretarsal region of the paralytic upper eyelid. Pretreatment, posttreatment, and follow-up photographs were digitized, and overall outcomes assessed. Measurements of lagophthalmos were standardized and compared. Slit-lamp examination was used to evaluate the degree of exposure keratopathy. ImageJ was used for photographic analysis. Results: Ten eyelids (9 patients, 7 men; mean age 69.2 years; range, 31-90 years) with paralytic lagophthalmos were treated with hyaluronic acid gel. The average amount of injected hyaluronic acid gel was 0.9 ml (range, 0.2-1.2 ml). All patients demonstrated significant improvement in lagophthalmos and exposure keratopathy. The mean improvement in lagophthalmos was 4.8 mm (range, 0.9-11.9 mm; p = 0.001). Of the 5 patients with follow-up, the mean follow-up period was 3.6 months (range, 2-5 months). Of these, 2 had no change in lagophthalmos (both maintained 0 mm at 5 months), one had a slight decrease in lagophthalmos (4.8-4.6 mm at 2 months), one had a slight increase in lagophthalmos (0.3- 0.5 mm at 2 months), and one had a more significant increase in lagophthalmos (1.9-4.3 mm at 4 months). The latter patient underwent a second treatment with further reduction of lagophthalmos to 0.4 mm. Overall, there was a decrease in margin reflex distance from the upper eyelid margin to the corneal light reflex (MRD1) but it was not statistically significant. Complications were minor and included transient ecchymosis, edema, and tenderness at the injection sites. Conclusions: On the basis of these preliminary results, hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of paralytic lagophthalmos. This treatment may be particularly useful in patients who are poor surgical candidates and/or as a temporizing measure in patients in whom return of facial nerve function is anticipated, given the hyaluronic acid gel's properties of slow resorption and reversibility with hyaluronidase.

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