Repeated triamcinolone acetonide injection in the treatment of upper-lid retraction in patients with thyroid-associated ophthalmopathy

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

“…It has been suggested that smaller injection volumes, shorter needles and an injection site more distant from the globe could prevent severe IOP elevation 51. LPS diameter reduction was observed in patients treated with TA,54 as previously seen on extra-ocular muscles after intraorbital injections 52. Although prior studies reported cases of increased IOP that responded successfully to topical medications, glaucoma should be considered a contraindication for this therapy and the importance of careful IOP follow-up needs to be reinforced.…”

“…Xu et al published the results of 21 patients (35 eyes) monthly treated with upper eyelid subconjunctival TA 54. All the treated patients showed improvement in UER, with a mean reduction in MRD1 of 2.19 mm after 6 months.…”

Peri‐levator palpebrae superioris triamcinolone injection for the treatment of thyroid eye disease‐associated upper eyelid retraction

“…The use of local corticosteroids for treating upper lid retraction has shown promising results using the subconjunctival route. Xu et al reported an improvement of upper lid retraction of 2.31 mm with radiographic evidence of reduction in size of the LPS/SR muscle complex after three monthly injections . Further series have demonstrated significant improvements in upper lid retraction and lagophthalmos .…”

“…The use of subconjunctival botulinum toxin to the upper eyelid has been reported but is both costly and may be less effective in the congestive phase of TED . Recent reports of subconjunctival corticosteroid injections have shown to be effective in reducing upper lid retraction, especially in patients in the congestive phase of TED . Given the histopathological changes found within the LPS/SR muscle complex, the authors propose a modified technique of injecting tiramcinolone around the involved LPS muscle complex in patients in with TED‐associated upper eyelid retraction.…”

“…Further series have demonstrated significant improvements in upper lid retraction and lagophthalmos . Series using the subconjunctival route suggest that there is a window period for treatment response; and patients in the congestive phase respond better than those in the fribrotic stage …”