title: Nonsurgical management of congenital eyelid malpositions using hyaluronic Acid gel.
abstract: OBJECTIVE
  To report our preliminary experience using hyaluronic acid gel fillers as a nonsurgical alternative in the management of congenital eyelid malpositions.
  
  
  METHODS
  In this retrospective interventional case series, 5 patients (10 eyes) with congenital eyelid malpositions, including eyelid retraction, ectropion, euryblepharon, epiblepharon, and abnormalities associated with a shallow orbit, with resultant lagophthalmos and/or keratopathy and tearing were evaluated before and after injection with hyaluronic acid gel (Restylane) in the pretarsal and/or septal regions of the affected eyelid(s). Pretreatment, posttreatment, and follow-up photographs were analyzed for eyelid position and degree of eyelid closure and lagophthalmos, and slit-lamp evaluation of the degree of keratopathy.
  
  
  RESULTS
  All 5 patients demonstrated significant improvement of eyelid position and degree of keratopathy. The mean improvement in lagophthalmos was 4.5 mm (range, 2-7 mm). The average volume of hyaluronic acid gel used was 0.5 ml per eyelid. Complications were minor, including transient edema and ecchymosis at the sites of injection. Of the 10 eyelids injected, only one had increased astigmatism after injection.
  
  
  CONCLUSIONS
  Hyaluronic acid gel shows promise as a safe and effective nonsurgical treatment for the management of certain eyelid malpositions, disorders traditionally requiring surgical intervention if aggressive ocular lubrication fails. This treatment is particularly useful in such patients who are commonly premature with poor general health and serves as a temporizing measure by allowing the much needed tissue expansion to take effect over time.
authors.affiliation: Division of Orbital and Ophthalmic Plastic and Reconstructive Surgery, Jules Stein Eye Institute, Los Angeles, California 90095, USA.
authors.forename: Mehryar
authors.initials: M
authors.lastname: Taban
authors.forename: Ronald
authors.initials: R
authors.lastname: Mancini
authors.forename: Tanuj
authors.initials: T
authors.lastname: Nakra
authors.forename: Federico G
authors.initials: FG
authors.lastname: Velez
authors.forename: Noa
authors.initials: N
authors.lastname: Ela-Dalman
authors.forename: Angelo
authors.initials: A
authors.lastname: Tsirbas
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Douglas
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D005124:Eye Abnormalities / Q000175:diagnosis / Q000188:drug therapy*; D005143:Eyelids / Q000002:abnormalities*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007267:Injections; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006820:Hyaluronic Acid; C445361:Restylane