Opportunities for globe dislocation correction in hemifacial atrophy

Relevance Hemifacial atrophy is a rare unilateral disease characterized by localized and progressive atrophy of the skin and subcutaneous tissues of the face. In 40% of cases, patients have ophthalmological manifestations in the form of iritis, pupillary anomalies, scleromalacia, changes in the extraocular muscles, and retinal pigment epithelium. However, the most common symptom is enophthalmos [1]. Treatment tactics are usually surgical with the placement of an orbital implant, but an alternative approach is possible in the form of intraorbital injections based on hyaluronic acid filler [2]. Objective To evaluate the effectiveness of non-surgical correction of enophthalmos in patients with hemifacial atrophy. Material and methods This retrospective study presents a series of cases with hemifacial atrophy. Patient demographics, age at onset, history of orbital and eyelid surgeries, diplopia, enophthalmos, limited ocular motility before and after injection, and number of injections were assessed. In all cases, the hyaluronic acid filler Restylane Sub-Q + Lidocaine (Galderma) was used, which was administered according to the previously proposed technique in a volume of 2 ml retrobulbarly with a cannula into the extraconal space [3]. Results A total of 8 injections were performed in 3 patients with hemifacial atrophy and significant enophthalmos. All patients were women aged 32, 24, and 52 years, and their symptoms debuted at 15, 16, and 30 years, respectively. No orbital surgeries were performed before the injection. The observation period was 2, 7, and 5 years, respectively. All patients had significant enophthalmos of 4 mm, which decreased to 1 mm after injection, and the duration of the effect was 18; 24 and 20 months, respectively. We observed significant improvement in enophthalmos, lagophthalmos, exposure keratopathy and upper eyelid excursion. Lagophthalmos improved from 1; 4 and 7 mm to 0; 1 and 2 mm after injection. Ocular motility improved without the development of new limitation or diplopia. When the effect regressed, repeat injections were performed in a smaller volume, which is associated with partial preservation of the filler in the orbit according to CT data, as well as experimental studies [4, 5]. Conclusion Intraorbital injections of hyaluronic acid have shown a positive effect in a series of patients with hemifacial atrophy and enophthalmos. Key words: hemifacial atrophy; enophthalmos; hypophthalmos; fillers; hyaluronic acid