title: Use of hyaluronic Acid gel in the management of paralytic lagophthalmos: the hyaluronic Acid gel "gold weight".
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Orbital and Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Mancini
authors.forename: Mehryar
authors.initials: M
authors.lastname: Taban
authors.forename: Alan
authors.initials: A
authors.lastname: Lowinger
authors.forename: Tanuj
authors.initials: T
authors.lastname: Nakra
authors.forename: Angelo
authors.initials: A
authors.lastname: Tsirbas
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Douglas
authors.forename: Norman
authors.initials: N
authors.lastname: Shorr
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001767:Blinking / Q000502:physiology; D005141:Eyelid Diseases / Q000188:drug therapy* / Q000503:physiopathology; D005143:Eyelids / Q000187:drug effects* / Q000503:physiopathology; D005158:Facial Paralysis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005782:Gels; D006820:Hyaluronic Acid