Análise morfométrica da fenda palpebral de pacientes com oftalmopatia distireóidea antes e após aplicação de toxina botulínica tipo A

Abstract

RESUMOIntrodução: A toxina botulínica tem sido usada como opção terapêutica para retração palpebral em pacientes com oftalmopatia distireóidea. Os objetivos deste trabalho foram apresentar dados morfométricos da fenda palpebral, avaliar o efeito da medicação sobre a função do músculo elevador da pálpebra superior e em relação à exposição ocular. Métodos: Foram incluídos 7 pacientes com retração palpebral. A propedêutica foi realizada com o registro de imagens através de câmera filmadora digital. Foram utilizados programas para edição dos vídeos e para análise da fenda palpebral. Também foi realizada a medida da função do tendão do músculo elevador da pálpebra superior e a propedêutica do filme lacrimal. Resultados: Os dados morfométricos mostraram uma diminuição da fenda palpebral e da distância entre a margem da pálpebra superior e o reflexo luminoso no centro da córnea, a função do músculo elevador da pálpebra superior apresentou uma diminuição de seu valor e a propedêutica do filme lacrimal evidenciou uma maior estabilidade do filme lacrimal após o uso da medicação. Discussão: A toxina pode ser uma opção de tratamento para pacientes com retração palpebral, amenizando o problema estético e os sinais de exposição corneana. Introduction: Botulinum toxin is an alternative treatment for retraction of ocular thyroid related dysfunction. The aim of this study was to evaluate the effects of this medication on upper lid position, levator palpebrae superioris muscle function and corneal exposure. Methods: Seven patients were enrolled into the study. The palpebral fissure images were acquired by a digital camera and transferred to a computer video edition program in order to be processed and analyzed. The levator palpebrae superioris muscle function and lacrimal film tests were also studied. Results: The distance between upper eyelid superior margin and light reflection on the center of the cornea had a significantly reduction in its measurements after toxin injection. The muscle function was diminished and there were improvement in corneal exposure after treatment. Discussion: Botulinum toxin injection could be an alternative treatment for upper eyelid retraction; it may relieve symptoms and improve eye appearance.

Correlation of Levator‐Muller's Complex Thickness on Ultrasound Biomicroscopy to Botulinum Toxin A Injection in Thyroid‐Related Upper Eyelid Retraction

“…Nonsurgical treatment for correction of UER is temporary and includes injection of BTA or steroid in levator aponeurosis, or hyaluronic acid gel fillers. [6][7][8][9][10][11][12][13][14][15]17,18 It lowers the eyelid position and thereby improves symptoms of dryness and facial appearance. The procedure is usually considered in patients waiting for the attainment of eyelid stability or those not willing for surgery.…”

“…Studies on the effect of injection BTA in thyroid-related UER have shown that the response in correction of eyelid retraction varies between 1.7 and 4.24 mm (Supplementary Table 1). [6][7][8][9][10][11][12][13][14][15]17,18 To understand the reason for the variable response, we studied the correlation between the LMC thickness on UBM and clinical response to injection BTA in patients with thyroid-related UER. We also compared the LMC thickness in thyroid-related UER with normal controls and clinical response to BTA.…”

“…6 In most of the studies, the amount of BTA varied between 2.5 units and 20 units, which depended subjectively on the severity of eyelid retraction. [6][7][8][9][10][11][12][13][14]22 We studied 13 patients (26 eyes) and divided eyes with UER as group 1 (n, 17 eyes) and eyes without UER as group 2 (n, 9 eyes). Mean MRD1 and VPA were significantly more in group 1 than in group 2 with lagophthalmos present in 9 eyes in group 1 and none in group 2.…”

“…Maximum effect was achieved at 1-month follow-up with the mean reduction in MRD1 being 1.88 AE 0.97 mm (range, 1.75-4.24 mm) which was found to be similar to other studies that reported a reduction in eyelid position between 1.75 and 4.24 mm. [6][7][8][9][10][11][12][13][14][15] Previous studies have shown that the effect of BTA varies between different individuals with the minimum duration of the effect being 1 month and maximum effect being 40 months. [6][7][8][9][10][11][12][13][14][15]17,18,20,22 Various clinical parameters such as age of the patient, duration of symptoms, history of thyroid disease, the severity of eyelid retraction, dose of BTA, and exophthalmometry values were compared with the reduction in MRD1 at 1-month follow-up.…”

“…[3][4][5] Published literature shows an unpredictable response to botulinum toxin A (BTA) injection in patients with thyroid-related UER. [6][7][8][9][10][11][12][13][14][15] To understand the underlying reason, we studied the levator-Muller's muscle complex (LMC) thickness on UBM and correlated with the clinical response to BTA injection in patients with inactive-stage of thyroid-related UER. To the best of our knowledge, there are no similar studies in the literature.…”