Hyaluronic Acid Gel Injection for Upper Eyelid Retraction in Thyroid Eye Disease

Abstract

Despite variability in the HA gel distribution and long-term conformational changes on ultrasound examination, HA injection may be an effective and minimally invasive method to improve upper eyelid position for patients with mild eyelid retraction in both the active and inactive stages of TED.

Current trends in the management of thyroid eye disease

“…A nonsurgical alternative is hyaluronic acid injection into the levator plane. A prospective study of eight patients showed an MRD1 decrease from 5.6 to 5 mm at 15 months following this technique [37]. Upper eyelid weights have also shown promise in treating upper eyelid retraction from TED.…”

Non-surgical treatment for eyelid retraction in thyroid eye disease (TED)

“…A significant decrease in the MRD1 (from an average of 5.6 mm to 4.6 mm) was observed at initial follow-up (mean of 1.4 months). MRD1 remained lower than the initial measurement (average of 5.0 mm) at the final follow-up (15 months after HA injection), with the active TED group having better results than the inactive group 34. Of note, the patients in the inactive group had all undergone prior surgical intervention, which may have affected their results.…”

“…In the TED group, the mean pretreatment margin reflex distance-1 (MRD1) asymmetry of 1.7 mm was reduced to 1.2 mm after 0.2–0.4 mL of HA were injected on the upper eyelid. Kohn et al assessed the effects of Restylane on unilateral upper eyelid retraction in eight TED patients 34. HA was injected subconjunctivally into the levator plane.…”

“…Overall, these studies indicate that HA may represent a safe, effective and predictable non-surgical alternative for eyelid malposition, especially for poor surgical candidates or medically unstable patients. Further, HA may be more effective in active TED,34 making it an important tool in the management of ocular exposure symptoms before disease stabilisation. Theoretically, fibrosis may diminish the therapeutic effect of HA, and it may be more beneficial if administered before tissue remodelling has occurred.…”

Non-aesthetic indications for periocular hyaluronic acid filler treatment: a review

“…A prospective, functional and dynamic ultrasound study by Kohn et al 10 of HA gel injections for upper eyelid retraction secondary to TED was performed on eight patients either in the inactive or active stage of TED. Multiple subconjunctival injections of Restylane-L (Medicis Aesthetics, Scottsdale, Arizona, USA) in the levator aponeurosis plane were performed to facilitate a good contour.…”