This is a retrospective review of three patients with enophthalmos in sighted eyes secondary to Parry-Romberg syndrome. The patients were all female, aged between 24 and 54. All three patients had 4mm of relative enophthalmos prior to treatment. They each received injections of up to 2ml of hyaluronic acid into the floor of the orbit via a transcutaneous infero-lateral approach, with a small amount directed supero-medially via the same injection site. They respectively received two, four and two injections, between 18 and 31 months apart. After each injection the enophthalmos reduced to 1mm. The effects lasted for 18-24 months. There were no complications apart from one case of worsening lower lid retraction. Lagophthalmos and corneal exposure also improved, presumably secondary to a reduction in the retraction of the upper lid tissue. Interestingly the authors also found an improvement in ocular motility in both patients who had restrictions, although they do not suggest a mechanism to explain this. They do discuss the potential risks and describe two other patients who developed vaso-vagal symptoms, which they found could be prevented with a prior injection of local anaesthetic.

Deep orbital Sub-Q hyaluronic acid filler injection for enophthalmic sighted eyes in Parry-Romberg syndrome.
Feldman I, Sheptulin VA, Grusha YO, Malhotra R.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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