Major Article
Nonsurgical correction of epiblepharon using hyaluronic acid gel

https://doi.org/10.1016/j.jaapos.2017.12.018Get rights and content

Purpose

To report a single-center experience with nonsurgical correction of epiblepharon using hyaluronic acid gel.

Methods

The medical records of consecutive patients with symptomatic epiblepharon treated over a 3-year period with hyaluronic acid gel injection were reviewed retrospectively. Hyaluronic acid gel was injected transcutaneously into the suborbicularis plane to obliterate the abnormal skin fold or evert the eyelid margin. Successful treatment was defined as eversion of the eyelid margin as assessed by lash-cornea touch.

Results

Ten eyelids of 8 patients (7 girls [88%]) underwent transcutaneous hyaluronic acid gel injection for correction of epiblepharon. Average age at presentation was 16.5 months (range, 1-72 months). Two patients had bilateral involvement. Of 10 eyelids, 8 had a distinct skin fold with a “valley” above it. Nine of 10 eyelids had lash-cornea touch in the primary gaze; 1 in downgaze. All 10 eyes had punctate corneal epitheliopathy on fluorescein staining. An average of 0.19 ml (range, 0.1–0.3 ml) of hyaluronic acid gel was injected per eyelid. After injection, 9 of 10 eyelids showed no lash-cornea touch in downgaze, and all 10 eyelids showed resolution of symptoms and epitheliopathy. Patients remained symptom-free for an average final follow-up of 19.1 months (range, 5-42 months). No procedure-related complications were noted.

Conclusions

In our small case series, transcutaneous hyaluronic acid gel injection into the lower eyelid effectively corrected symptomatic epiblepharon; the effect was long lasting.

Section snippets

Subjects and Methods

The clinical records of all patients with epiblepharon who were treated with hyaluronic acid gel injection from 2009 to 2012 at the LV Prasad Eye Institute, Hyderabad, were retrospectively reviewed. The study was approved by the Institutional Review Board of LV Prasad Eye Institute. The following data were collected: demographic profile, extent of epiblepharon, and outcomes following hyaluronic acid gel injection. Only symptomatic patients with epiphora or reflex spasm and corneal

Results

A total of 10 eyelids of 8 patients with epiblepharon underwent hyaluronic acid gel injection during the study period. Patient demographics, relevant clinical findings, treatment outcome, and final follow-up of all 8 patients are provided Table 1.

The average age at presentation was 16.5 months (range, 1-74). Six patients had unilateral epiblepharon; 2 cases had bilateral involvement. Seven of the 10 eyelids showed a distinct skin fold in the lower eyelid. Nine eyelids had lash-cornea touch in

Discussion

Epiblepharon is believed to be a self-limiting condition, which corrects itself as the patient ages. In mild, asymptomatic cases, simple observation with conservative management is sufficient. Severe cases, with corneal epithelial keratopathy, may require surgical management. The nonsurgical treatment we report here can be a good alternative to surgery in moderate cases.5, 6 Transcutaneous injection allows easy visualization of the plane of filler delivery and makes it easy to fill the eyelid

References (6)

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