Hyaluronic acid gel (HAG) fillers
Hyaluronic acid gel (HAG) fillers have been used in intraocular surgery for decades. The aesthetic uses of HAG products such as Juvederm (Allergan) and Restylane (Nestle Skin Health) are well known and offer a popular method of non-invasive facial rejuvenation. However, more recently, the functional use of fillers to improve eyelid malposition or mid-face revolumization has shown promise.
HAG has been found to be as efficacious as allograft dermal grafting or hard palate grafting to improve the position of the lower eyelids,16 as well as to improve and restore normal eyelid anatomy to correct lagophthamos, congenital ectropion, upper eyelid retraction, among other malpositions.17
Clearly, ophthalmology, dermatology, and aesthetics benefit each other through shared medications and technologies. In the future, we anticipate seeing many more crossovers and “adopted” technologies used routinely in ophthalmology.
1. Liu R, Rong B, Tu P, et al. Analysis of Cytokine Level in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. AJO. 2017 Nov;183: 81-90.
2. Craig JP, Chen YH, Turnbull PR. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2015 Feb 12;56(3):1965-70.
3. unpublished data
4. Yin Y, Liu N, Gong L, Song N. Changes in the Meibomian Gland After Exposure to Intense Pulsed Light in Meibomian Gland Dysfunction (MGD) Patients. cure Eye Res. 2018 Mar;43(3): 308-313.
5. Scott AB, Miller JM, Shieh KR. Treating Strabismus by Injecting the Agonist Muscle with Bupivacaine and the Antagonist with Botulinum Toxin. Trans Am Ophthalmol Soc. 2009 Dec;107:104-109.
6. Romanov A, Pokushalov E, Ponomarev D, et al. Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study. Heart Rhythm. 2019 Feb;16(2):172-177.
7. Park J, Park HJ. Botulinum Toxin for the Treatment of Neuropathic Pain. Toxins (Basel). 2017 Sep; 24;9(9):260.
8. Diel RJ, Kroeger ZA, Levitt RC, et al. Botulinum Toxin A for the Treatment of Photophobia and Dry Eye. Ophthalmology. 2018 Jan; 125(1): 139–140.
9. Ho MC, Hsu WC, Hsieh YT. Botulinum Toxin Type A Injection for Lateral Canthal Rhytids. JAMA Ophthalmol. 2014;132(3):332-337.
10. Lu R, Huang R, Li K, et al. The influence of benign essential blepharospasm on dry eye disease and ocular inflammation. Am J Ophthalmol. 2014 Mar;157(3):591-7.e1-2.
11. Gumus K, Lee S, Yen MT, Pflugfelder SC. Botulinum toxin injection for the management of refractory filamentary keratitis. Arch Ophthalmol. 2012 Apr;130(4):446-50.
12. Sahlin S, Chen E, Kaugesaar T. Effect of eyelid botulinum toxin injection on lacrimal drainage. Am J Ophthalmol. 2000 Apr;129(4):481-6.
13. Fouda SM, Mattout HK. Comparison Between Botulinum Toxin A Injection and Lacrimal Punctal Plugs for the Control of Post-LASIK Dry Eye Manifestations: A Prospective Study. Ophthalmol Ther. 2017 Jun;6(1):167-174.
14. Singh S, Ali MJ, Paulsen F. A review on use of botulinum toxin for intractable lacrimal drainage disorders. Int Ophthalmol. 2018 Oct;38(5):2233-2238.
15. Mérida S, Palacios E, Navea A, Bosch-Morell F. New Immunosuppressive Therapies in Uveitis Treatment. Int J Mol Sci. 2015 Aug 11;16(8):18778-95.
16. Goldberg RA, Lee S, Jayasundera T, et al. Treatment of lower eyelid retraction by expansion of the lower eyelid with hyaluronic Acid gel. Ophthalmic Plast Reconstr Surg. 2007 Sep-Oct;23(5):343-8.
17. Mancini R. Managing eyelid malpositions with hyaluronic acid gel injections. Int Ophthalmol Clin. 2013 Summer;53(3):11-20.