Abstract ID: 26-176
Extensive Subconjunctival and Orbital Hyaluronic Acid Filler Migration Following Superior Sulcus Augmentation
Author: Angkoon Luangaram Base Hospital / Institution: Bangkok Nursing Home Hospital
Presentation Type: ePoster Presentation
Purpose
To describe hyaluronic acid (HA) filler migration after superior sulcus augmentation presenting as a combined subconjunctival and orbital mass, and to summarise imaging, surgical management, and key long‐term management concepts from the literature.
Methods
Retrospective case report. Evaluation included ophthalmic examination and orbital MRI. Transconjunctival excision under local anaesthesia was performed with intraoperative video. Excised tissue was examined with haematoxylin–eosin and Alcian blue staining. Postoperative reviews were at one and two weeks.
Results
A 27-year-old woman presented with a four-month painless, enlarging subconjunctival mass in the left eye following two HA filler sessions for bilateral superior sulcus eight and one months earlier, with greater total volume on the left. The mass appeared as a translucent, jelly-like lesion arising from the superior fornix without inflammatory signs. Visual acuity was 20/20, and ocular motility was full. MRI showed T2-hyperintense, T1-hypointense material extending posteriorly along the superior rectus muscle. Intraoperatively, numerous gelatinous granules were found inseparably infiltrating the Tenon’s capsule. The anterior component was fully excised, while the deeper orbital part was left in place. Histopathology confirmed an HA-based substance. Postoperatively, the vision and ocular motility remained intact.
Conclusion
HA filler injection, especially in the postseptal plane, carries a risk of migration into both subconjunctival and orbital planes. MRI is essential for evaluating the extent beyond the visible mass. Transconjunctival excision is preferred over hyaluronidase for the subconjunctival component, given immediate removal and tissue diagnosis, whereas the safety of hyaluronidase for this location remains unclear. For asymptomatic orbital residuals, observation is reasonable given the potential risks of orbitotomy and orbital hyaluronidase injections. Long-term surveillance is necessary to detect delayed complications such as granuloma, myositis, or fibrosis.