Intralesional tetracycline injection for treatment of lower eyelid festoons: a preliminary report.
OBJECTIVE
To determine the safety and effectiveness of intralesional tetracycline 2% injection for the treatment of lower eyelid festoons.


METHODS
The authors retrospectively reviewed the charts of all patients undergoing tetracycline 2% injection of lower eyelid festoons at the Cole Eye Institute from August 2008 to August 2013. Charts were reviewed for patient demographic data, dose and number of tetracycline injections, follow-up interval, the presence of preinjection and postinjection photographs, and complications. Charts without preinjection and postinjection photographs were excluded from review. The preinjection and postinjection photographs were randomized, masked, and graded by 4 independent examiners. Photographs were graded on a scale of 0 (no festoon) to 4 (severe festoon). Student t test was used for statistical analysis.


RESULTS
Eleven patients met inclusion criteria. Each patient underwent bilateral injection. Average follow up was 121 days (range, 18-586 days). Patients received up to 0.75 ml (mean, 0.24 ml) of tetracycline 2% per side. Average preinjection grade was 2.1 (standard deviation, 0.89; range, 0-3), and average postinjection grade was 1.2 (standard deviation, 0.72; range, 0-2; p < 0.001). Three patients had follow up less than 60 days (mean, 34 days), with an average preinjection grade of 1.96 and postinjection grade of 1.23 (p < 0.001). Five patients had follow up between 60 and 100 days (mean, 82 days), with an average preinjection grade of 2.18 and postinjection grade of 1.38 (p < 0.001). Three patients had follow up longer than 100 days (mean, 275 days), with an average preinjection grade of 2.08 and postinjection grade of 0.78 (p < 0.001). Complications other than pain and bruising were not identified in any patient.


CONCLUSIONS
Intralesional tetracycline 2% injection may offer a safe option to treat lower eyelid festoons. Complications such as cutaneous ischemia or necrosis were not identified in any patient. Further study may determine optimal treatment doses and intervals and detect infrequent but significant complications.
*Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; and †Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, U.S.A.
Julian D
JD
Perry
Viraj J
VJ
Mehta
Bryan R
BR
Costin
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004487:Edema / Q000188:drug therapy* / Q000503:physiopathology; D005141:Eyelid Diseases / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D010781:Photography; D012189:Retrospective Studies; D013752:Tetracycline / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D013752:Tetracycline