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.