Subconjunctival Injection of Triamcinolone for the Treatment of Upper Lid Retraction Associated With Thyroid Eye Disease

Abstract

Management of retraction of the upper lid during the congestive phase of thyroid eye disease is usually limited to conservative treatment. We evaluated the efficacy of subconjunctival injection of triamcinolone for the treatment of the upper lid retraction associated with thyroid eye disease.Thirty patients (43 eyes, 11 men and 19 women) with the upper lid retraction associated with thyroid eye disease were evaluated between May 2009 and September 2010. A dose of 0.5 mL of triamcinolone acetonide (40 mg/mL) was injected into the subconjunctival space at the upper margin of the tarsus. If the upper lid retraction had not improved or was still severe 2 weeks after the initial injection, then triamcinolone was injected repeatedly at 2-week intervals. Photographs were taken before the injection and at the follow-up visit, and lid parameters including marginal reflex distance 1, interpalpebral fissure height, total palpebral fissure area, the upper nasal palpebral fissure area, and the upper temporal palpebral fissure area were measured. Changes in the lid parameters after the injection were evaluated.The mean number of injections per patient was 2.67, and the mean (SD) follow-up period was 260.97 (91.10) days. All lid parameters improved significantly after the triamcinolone injection (all P's < 0.05). Nineteen of 22 patients in the congestive phase responded to the triamcinolone injection; however, 6 of 8 patients in the fibrotic phase did not respond to the triamcinolone injection. Complications associated with the triamcinolone injection included an increased intraocular pressure (2 patients) and a mild ptosis (1 patient).The subconjunctival triamcinolone injection is a simple and effective treatment option for the upper lid retraction associated with thyroid eye disease, and this treatment is more effective for the patients in the congestive phase.

Clinical efficacy of transcutaneous triamcinolone acetonide injection for upper eyelid retraction and swelling in patients with thyroid eye disease

“…Upper eyelid swelling was evaluated by the orbital fat around LPS muscle and the retro-orbicularis oculi fat (ROOF) thickness with sagittal MRI. To assess the potential for TA-induced complications, 22 – 24 intraocular pressure was measured before and at 1, 3, 6 and 12 months after treatment. Patients were also questioned about any other problems including menstrual disorders.…”

“… 21 – 24 Several reports suggested that subconjunctival TA injections resulted in an improvement of eyelid retraction in 68%–75% of patients from 1 to 4 times. 22 – 24 In addition, it was reported that such injection reduces inflammatory enlargement of the LPS muscle 23 and upper eyelid swelling. 24 However, subconjunctival TA injection causes increased intraocular pressure 22 – 24 and menstrual irregularities.…”

“… 22 – 24 In addition, it was reported that such injection reduces inflammatory enlargement of the LPS muscle 23 and upper eyelid swelling. 24 However, subconjunctival TA injection causes increased intraocular pressure 22 – 24 and menstrual irregularities. 23 …”

Non-surgical treatment for eyelid retraction in thyroid eye disease (TED)

“…Lee et al studied the effect of TA subconjunctival injection in patients in the active phase, and compared them with inactive, euthyroid patients 56. More profound improvement was found in the active group when compared with the inactive (86.3% of the patients in the active group showed improvement vs 25% of the inactive), as observed previously 54 55.…”

Local Use of Dexamethasone in the Treatment of Ocular Myasthenia Gravis

“…Local treatment with topical corticosteroids has been recommended as rst-line treatment for juvenile idiopathic arthritis (JIA)-associated uveitis, when the disease is mild and patients can be weaned relatively quickly off of steroid therapy [12,13]. The topical injection of hormone drugs such as triamcinolone acetonide or dexamethasone also has been used successfully for the treatment of thyroid-related ophthalmopathy [14,15]. Alkawas et al compared the e cacy of peribulbar triamcinolone acetonide to oral prednisone in the treatment of thyroidassociated ophthalmopathy.…”