title: Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients.
abstract: BACKGROUND
  Hyaluronidase (Hylase Dessau(®)) is a hyaluronic acid-metabolizing enzyme, which has been shown to loosen the extracellular matrix, thereby improving the diffusion of local anesthetics. Lower eyelid edema is a common post-interventional complication of cosmetic procedures performed in the lid region, such as the injection of hyaluronic acid fillers for tear-trough augmentation. The purpose of this study was to validate the efficacy of hyaluronidase in the management of lower eyelid edema.
  
  
  METHODS
  We performed a retrospective analysis with 20 patients with lower eyelid edema. Most patients (n = 14) presented with edema following hyaluronic acid injection (tear-trough augmentation), whereas the minority (n = 6) were treated due to idiopathic edema (malar edema or malar mounds). Patients were treated by local infiltration of approximately 0.2 ml to 0.5 ml of hyaluronidase (Hylase Dessau(®) 20 IU to 75 IU) per eyelid. Photographs were taken prior to and seven days after infiltration.
  
  
  RESULTS
  Hyaluronidase was found to reduce effectively and rapidly or resolve eyelid edema after a single injection. No relevant adverse effects were observed. However, it must be noted that a hyaluronidase injection may also dissolve injected hyaluronic acid fillers and may therefore negatively affect tear-trough augmentations. While the effects of a treatment for edema due to tear-trough augmentation were permanent, malar edema and malar mounds reoccurred within two to three weeks.
  
  
  CONCLUSIONS
  The infiltration of hyaluronidase is rapid, safe and currently the only effective option for the management of eyelid edema. No relevant adverse effects were observed.
authors.forename: Said
authors.initials: S
authors.lastname: Hilton
authors.forename: Holger
authors.initials: H
authors.lastname: Schrumpf
authors.forename: Bettina Alexandra
authors.initials: BA
authors.lastname: Buhren
authors.forename: Edwin
authors.initials: E
authors.lastname: Bölke
authors.affiliation: Department of Dermatology, Heinrich-Heine University Dusseldorf, Medical Faculty, Moorenstr 5, D-40225 Dusseldorf, Germany. peterarne.gerber@med.uni-duesseldorf.de.
authors.forename: Peter Arne
authors.initials: PA
authors.lastname: Gerber
mesh_terms: D000328:Adult; D000368:Aged; D003357:Cosmetic Techniques; D004487:Edema / Q000188:drug therapy* / Q000209:etiology; D005141:Eyelid Diseases / Q000188:drug therapy* / Q000209:etiology; D005143:Eyelids / Q000601:surgery; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase