A 44-year-old woman was referred with 3 mm of left enophthalmos and a
deep superior sulcus. She was diagnosed 6 months earlier with silent
sinus syndrome and had undergone a left middle-meatal antrostomy with
improvement of her hypoglobus but not of her enophthalmos and superior
sulcus deformity. Two milliliters of Restylane SubQ (Q-Med AB, Uppsala,
Sweden) was injected as a single bolus in the intraconal and extraconal
posterior orbit via a standard transcutaneous inferotemporal approach
using a primed green 21-gauge needle. Immediate reduction of
enophthalmos by approximately 2 mm and superior sulcus improvement were
noted. This remained stable at 6 months. The symptoms and signs of
silent sinus syndrome can be effectively corrected with this minimally
invasive nonsurgical option. To our knowledge, the use of hyaluronic
acid gel for the treatment of enophthalmos in silent sinus syndrome has
not been previously reported
