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Doxycycline Injection for Sclerotherapy of Lower Eyelid Festoons and Malar Edema

Preliminary Results

Godfrey, Kyle J. M.D.*,†,‡; Kally, Peter M.D.; Dunbar, Kristen E. M.D.; Campbell, Ashley A. M.D.†,§; Callahan, Alison B. M.D.†,‖; Lo, Christopher M.D.†,¶; Freund, Robert M.D.#; Lisman, Richard D. M.D.†,‡

Ophthalmic Plastic & Reconstructive Surgery: September/October 2019 - Volume 35 - Issue 5 - p 474–477
doi: 10.1097/IOP.0000000000001332
Original Investigations
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Purpose: To investigate the safety and efficacy of direct, intralesional doxycycline hyclate injection for improving the appearance of cosmetically significant lower eyelid festoons and malar edema.

Methods: An Institutional Review Board approved, retrospective review was performed of 15 consecutive patients with malar edema and/or festoons injected with doxycycline hyclate at a concentration of 10 mg/ml. Pre- and postinjection photographs were reviewed and graded on a scale of 0 to 3 (0: no festoon; 1: small festoon; 2: medium festoon; 3: large festoon) by 2 masked physician observers. Patients were excluded from the final analysis if they received an alternate dose concentration, had incomplete photographic records, or did not follow up. Student t test was used for statistical analysis.

Results: Twenty consecutive treatment areas of 11 patients were included in the analysis. Final follow up ranged from 3 to 104 weeks, with a mean follow up of 22.5 weeks. The average (standard deviation) initial festoon grade of 2.5 (0.58) decreased to 0.9 (0.82) with a p value of <0.001. The average number of injections performed per side was 1.4 (range: 1–2). The mean volume per injection was 0.72 ml (range: 0.15–2.0 ml). Commonly documented subjective complaints were burning sensation with injection, pain, bruising, and erythema. There were no other dermatologic or visual complications following treatment.

Conclusions: These preliminary results suggest that intralesional injections of doxycycline hyclate at a concentration of 10 mg/ml may be an effective treatment option for cosmetically significant lower eyelid festoons and malar edema. Future prospective studies with increased patient numbers, increasing concentrations, combination therapies with local anesthetic or regional nerve blocks, and longer follow up are needed to validate these results and determine optimal injection technique.

Intralesional injection of doxycycline hyclate may improve the appearance of esthetically undesirable lower eyelid festoons and malar edema.

*Department of Ophthalmology, Weill Cornell Medical College, New York, New York

Department of Ophthalmology, New York University Langone Medical Center, New York, New York

Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York, New York

§Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland

Department of Ophthalmology, New England Eye Center at Tufts Medical Center, Boston, Massachusetts

Department of Ophthalmology, University of California Los Angeles, Los Angeles, California

#Department of Plastic Surgery, Lenox Hill Hospital, New York, New York, U.S.A.

The authors have no financial or conflicts of interest to disclose.

Presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery Fall Scientific Symposium on October 26, 2018 in Chicago, IL.

Address correspondence and reprint requests to Kyle J. Godfrey, M.D., Division of Ophthalmic Plastic, Reconstructive, and Orbital Surgery, Department of Ophthalmology, Weill Cornell Medical College, 1305 York Ave, New York, NY 10021 E-mail: kyg9004@med.cornell.edu

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.