title: Use of hyaluronic acid gel in the treatment of lagophthalmos in sunken superior sulcus syndrome.
abstract: OBJECTIVE
  To evaluate the use of hyaluronic acid gel in the management of lagophthalmos in sunken superior sulcus syndrome.
  
  
  BACKGROUND
  Lagophthalmos associated with orbital fat atrophy and deep superior sulcus is a known entity described previously. Orbital fat atrophy results in deep superior sulcus where skin, orbicularis muscle, and orbital septum retract posteriorly in the deep superior sulcus, leading to lagophthalmos from suboptimal orbicularis function and effective skin shortening. The authors define this condition as sunken superior sulcus syndrome (SSSS) when the deep superior sulcus leads to exposure keratopathy. Thus, the syndrome consists of deep superior sulcus, lagophthalmos, and exposure keratopathy. Although the use of hyaluronic acid gel has been proposed as a management option for paralytic lagophthalmos, its application in the treatment of lagophthalmos in SSSS has not been reported.
  
  
  METHODS
  In this study, 5 patients (10 eyelids) with SSSS were injected with hyaluronic acid gel in the superior sulcus of the upper eyelid. Injected amount was titrated until the desired point was reached: complete or nearly complete eyelid closure.
  
  
  RESULTS
  After an average follow up of 9.5 months, lagoph thalmos improved by 2 mm or 69% (p = 0.02) on the right side and by 1 mm or 71% (p = 0.01) on the left side. Most patients also reported significantly improved ocular comfort and appearance of the superior sulcus. The only complications noted were bruising and temporary uneven contour of the upper eyelid sulcus.
  
  
  CONCLUSIONS
  Management of lagophthalmos in SSSS with hyaluronic acid gel is an effective and safe alternative to surgery.
authors.affiliation: *Oculoplastic Surgery, Inc., Center for Facial Appearances, Salt Lake City, Utah; and †Department of Fine Arts, University of Tampa, Tampa, Florida, U.S.A.
authors.forename: Ilya M
authors.initials: IM
authors.lastname: Leyngold
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Berbos
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
authors.forename: Brett
authors.initials: B
authors.lastname: Pariseau
authors.forename: Ariel R
authors.initials: AR
authors.lastname: Leyngold
authors.forename: Richard L
authors.initials: RL
authors.lastname: Anderson
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D015841:Enophthalmos / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005141:Eyelid Diseases / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005143:Eyelids / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D056965:Injections, Intraocular; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology; D009915:Orbit / Q000473:pathology; D055675:Viscosupplements / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D005782:Gels; D055675:Viscosupplements; D006820:Hyaluronic Acid