*Oculoplastic Surgery, Inc., Center for Facial Appearances, Salt Lake City, Utah; and †Department of Fine Arts, University of Tampa, Tampa, Florida, U.S.A.
Ophthalmic Plast Reconstr Surg. 2014 Mar-Apr;30(2):175-9. doi: 10.1097/IOP.0000000000000040.
To evaluate the use of hyaluronic acid gel in the management of lagophthalmos in sunken superior sulcus syndrome.
Lagophthalmos associated with orbital fat atrophy and deep superior sulcus is a known entity described previously. Orbital fat atrophy results in deep superior sulcus where skin, orbicularis muscle, and orbital septum retract posteriorly in the deep superior sulcus, leading to lagophthalmos from suboptimal orbicularis function and effective skin shortening. The authors define this condition as sunken superior sulcus syndrome (SSSS) when the deep superior sulcus leads to exposure keratopathy. Thus, the syndrome consists of deep superior sulcus, lagophthalmos, and exposure keratopathy. Although the use of hyaluronic acid gel has been proposed as a management option for paralytic lagophthalmos, its application in the treatment of lagophthalmos in SSSS has not been reported.
In this study, 5 patients (10 eyelids) with SSSS were injected with hyaluronic acid gel in the superior sulcus of the upper eyelid. Injected amount was titrated until the desired point was reached: complete or nearly complete eyelid closure.
After an average follow up of 9.5 months, lagoph thalmos improved by 2 mm or 69% (p = 0.02) on the right side and by 1 mm or 71% (p = 0.01) on the left side. Most patients also reported significantly improved ocular comfort and appearance of the superior sulcus. The only complications noted were bruising and temporary uneven contour of the upper eyelid sulcus.
Management of lagophthalmos in SSSS with hyaluronic acid gel is an effective and safe alternative to surgery.
评估透明质酸凝胶在治疗凹陷性上睑沟综合征的睑裂闭合不全中的应用。
先前已经描述过与眶脂萎缩和深上睑沟相关的睑裂闭合不全。眶脂萎缩导致深上睑沟形成，皮肤、眼轮匝肌和眶隔向后退缩至深上睑沟，导致眼轮匝肌功能不佳和有效皮肤缩短导致的睑裂闭合不全。当深上睑沟导致暴露性角膜炎时，作者将这种情况定义为凹陷性上睑沟综合征（SSSS）。因此，该综合征包括深上睑沟、睑裂闭合不全和暴露性角膜炎。尽管已经提出使用透明质酸凝胶作为治疗麻痹性睑裂闭合不全的一种选择，但尚未报道其在治疗 SSSS 中睑裂闭合不全的应用。
本研究对 5 例（10 只眼睑）SSSS 患者在上睑的上睑沟内注射透明质酸凝胶。注射量滴定至达到所需的点：完全或几乎完全的眼睑闭合。
平均随访 9.5 个月后，右侧的睑裂闭合不全改善了 2mm，即 69%（p=0.02），左侧改善了 1mm，即 71%（p=0.01）。大多数患者还报告说，眼舒适度和上睑沟外观显著改善。唯一注意到的并发症是瘀伤和上睑沟暂时不均匀的轮廓。
用透明质酸凝胶治疗 SSSS 的睑裂闭合不全是一种有效且安全的手术替代方法。
