Hyaluronidase compositions and methods of using same for determining the etiology of peri-orbital puffiness

A method for determining an etiology of upper and/or lower eyelid periorbital puffiness in a subject and treating the subject, the method comprising:

• a. examining the upper and/or lower eyelid periorbital puffiness in the subject with and without squinted eyes;
• and
• b. determining that the upper and/or lower eyelid periorbital puffiness is anterior to an orbicularis oculi muscle if the upper and/or lower eyelid periorbital puffiness does not improve with squinted eyes, or determining that the upper and/or lower eyelid periorbital puffiness is posterior to the orbicularis oculi muscle if the upper and/or lower eyelid periorbital puffiness disappears or improves with squinted eyes,
• wherein if the upper and/or lower eyelid periorbital puffiness is determined to be anterior to the orbicularis oculi muscle, a protein having hyaluronidase activity is administered into the soft tissue anterior to the orbicularis oculi muscle of the subject, and
• wherein if the upper and/or lower eyelid periorbital puffiness is determined to be posterior to the orbicularis oculi muscle, the method further comprises
• determining if the upper and/or lower eyelid periorbital puffiness is secondary to pseudoherniation of upper and/or lower eyelid fat pads, edema of upper and/or lower eyelid fat pads, or upper and/or lower eyelid fat pad pseudoherniation and edema,
• wherein if the periorbital puffiness is due to pseudoherniation of the fat pads, surgery is performed to remove all or a portion of the fat pads, and
• wherein if the periorbital puffiness is due to pseudoherniation and edema of the fat pads, a protein having hyaluronidase activity is first injected into the fat pads before surgery to remove all or a portion of the fat pads.