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Eye (2008) 22, 311315 & 2008 Nature Publishing Group All rights reserved 0950-222X/08 $30.00
http://www.nature.com/eye
Web End =www.nature.com/eye
E Chee1 and S-P Chee1,2,3
Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series
CASE
SERIES
Abstract
Purpose To report the results of subconjunctival injection of triamcinolone in the treatment of thyroid eye disease-related lid retraction.Intervention Patients with either unilateral or bilateral upper lid retraction, secondary to thyroid eye disease, diagnosed during the period of February 2004 to June 2005 were recruited. An injection of 0.5 ml of triamcinolone acetonide (40 mg/ml kenalog) with 0.1 ml of 2% lignocaine was injected into the subconjunctival region of the lid between the conjunctiva and Mullers muscle under topical anaesthesia on upper lid eversion. Pre- and post-procedure measurements included lid aperture, marginal reex distance, the amount of lagophthalmos, and intraocular pressure measurements. Photographs were also obtained before the procedure and at subsequent visits. Follow-up was done at 2 weeks, 1, 3, 6 months and at 1 year. Results Three of the four patients had resolution of their upper lid retraction within 1 month of treatment, with one patient requiring a repeat triamcinolone injection. The patient who had brotic muscles did not respond to triamcinolone injections and required surgical correction. Conclusion Upper lid subconjunctival triamcinolone appears to be an effective treatment option in reducing lid retraction in patients with recent onset of thyroid eye disease.
Eye (2008) 22, 311315; doi:http://dx.doi.org/10.1038/sj.eye.6702933
Web End =10.1038/sj.eye.6702933 ; published online 5 October 2007
Keywords: subconjunctival; triamcinolone injection; lid retraction; thyroid eye disease
Introduction
Upper lid retraction has been attributed to various proposed mechanisms. The mechanisms include increased sympathetic tone in the Mullers muscle,1,2 levator muscle bre enlargement,3 levator muscle contracture or brosis, abnormal adhesions between the levator and adjacent structures3 or xation duress that results from contracture and restriction of the inferior rectus muscle with resultant increase in tone of the superior rectus and levator muscle when the affected eye attempts to xate.4,5 The typical
histopathological ndings of the extraocular muscles and orbital connective tissue that are seen in these patients show inammatory cell inltration, oedema, fatty degeneration, and collagen proliferation leading to muscle enlargement,5 supporting an immune-mediated inammatory process.
To date there have been...