Nonsurgical Treatment of Abnormal Eyelid Position Using Hyaluronic Acid Gel

PURPOSE: The present study investigated the outcomes of nonsurgical treatment of abnormal eyelid position using hyaluronic acid gel. METHODS: Abnormal eyelid position including 18 eyes with lid retraction, 10 eyes with lagophthalmos, and 18 eyes with ectropion were treated with hyaluronic acid gel. The mean age was 50 +/- 17.8 years and the mean observation period was 11 +/- 2.4 months. The photographs of patients were taken before injection, 1 month, 4 months, and at the last follow-up after injection. The marginal reflex distance 1 (MRD1) and marginal reflex distance 2 (MRD2) of patients were measured and analyzed by the Image J Program. The severity of ectropion was graded by a scoring system. RESULTS: Ten eyes with lagopthalmos improved 1.9 +/- 1.2 mm after injection. The 16 eyes with lid retraction improved 1.3 +/- 0.9 mm. Twenty-three eyes with ectropion improved and 17 eyes (81%) were completely corrected. The average frequency of injection was 1.1 and the average dose of injection was 0.4 +/- 0.12 cc. No significant complications were observed in any patient. CONCLUSIONS: Hyaluronic acid gel injections can be used safely and effectively as a nonsurgical treatment for patients with abnormal eyelid position without any significant complications.

Adult Orbital Xanthogranulomatous Disease in a 42-Year-Old Woman

PURPOSE: To report a case of adult orbital xanthogranulomatous disease presented as bilateral swelling and yellowish eyelids in a 42-year-old woman who was misdiagnosed with xanthelasma at a dermatologic clinic. CASE SUMMARY: A 42-year-old woman presented yellowish and swollen eyelids in both eyes of 2.5 year duration. She had no past history of systemic diseases or other ophthalmologic problems. MRI showed heterogeneous eyelid masses and hypertrophic changes of the lacrimal glands in both eyes. There were no abnormalities on chest X-ray exams. The blood cholesterol and low density lipoprotein levels were increased. Incisional biopsy showed many foamy histiocytes, lymphocytes with germinal centers, several touton giant cells, and negative S100/CD 1 staining; all being features consistent with adult onset xanthogranulomatous disease. CONCLUSIONS: In cases with bilateral swelling and yellowish colored eyelids, adult orbital xanthogranulomatous disease should be evaluated through biopsy and other systemic examinations.