涙袋へのヒアルロン酸製剤注入が原因で生じたと考えられる下眼瞼後退による睫毛内反症の1例

A Case of Epiblepharon Due to Lower-eyelid Retraction, Probably Caused by Multiple Hyaluronic Acid Injections into the Eye Bags

はじめに

　昨今，美容医療において注入療法が広く行われ，なかでもヒアルロン酸製剤は注入後の組織反応が比較的軽微なため用いられることが多い。しかし，注入後の合併症として急性期に発赤，腫脹，動脈塞栓，遅発性異物肉芽腫や瘢痕を生じるリスクがある 1）～4）。

　また，下眼瞼に対するフィラー注入や脱脂といった下眼瞼に対する美容外科施術は広く行われている一方で，合併症の報告も増えているのが現状である 5）～7）。

　今回われわれは，複数回にわたる涙袋へのヒアルロン酸製剤注入が原因で生じたと考えられる瘢痕性下眼瞼後退により睫毛内反症を来たした症例に対して，lower eyelid retractors（以下，LER）の瘢痕剥離およびturn-over orbital septal flapによるLER延長術を行い，良好な結果を得たため若干の文献的考察を加えて報告する。

　In recent years, injection therapy has become popular in the field of aesthetic surgery. Among the various available fillers, hyaluronic acid is used as a reliable substance because of its absorbency and relatively minor tissue reaction after injection. However, complications that have occurred with the use of hyaluronic acid include redness, swelling, and arterial embolization in the acute phase, and foreign-body granulomas and scarring in the delayed phase.

　We report our experience in the treatment of lower-eyelid epiblepharon and lower-eyelid retraction (an inferiorly displaced lower-lid margin) that resulted from multiple injections of hyaluronic acid into a patientʼs eye bags. Our technique involves surgical scar dissection of the lower-eyelid retraction and advancement by using a reversed orbital septum (septal turn-over flap) to properly correct the lower eyelidʼs position.

　As lower blepharoplasty becomes more popular, the prevalence of complications such as lower-eyelid retraction may increase. Our method requires only local manipulation without an internal spacer graft; this method can reduce the rate of the recurrence of lower-eyelid retraction and may be applicable to other postoperative complications of other lower-eyelid surgeries.