Subconjunctival Injection of Triamcinolone in The Treatment of Upper Lid Retraction Associated with Thyroid Eye Disease

1. Sehyun Baek¹
2. Jong Mi Lee²
3. Tae Eun Lee¹
4. Hwa Lee¹
5. Minsoo Park³
6. Hyung Ho Shin²

¹Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
²Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
³Kong Eye Center, Seoul, Korea

Purpose: To evaluate the efficacy of subconjunctival injection of triamcinolone in the treatment of upper lid retraction associated with thyroid eye disease

Methods: Fourteen patients (20 eyes, 4 men and 10 women) with upper lid retraction associated with thyroid eye disease were evaluated between May, 2009 and November, 2009. 0.5 ml of triamcinolone acetonide (40 mg/ml) was injected into the subconjunctival space at the upper margin of the tarsus. Follow-up was done at 2 weeks after injection, and if upper lid retraction was not improved or still severe, TA was injected repeatedly with 2 weeks interval. Photographs were taken before injection and at follow-up visit, and lid parameters including marginal reflex distance 1 (MRD1), interpalpebral fissure height (IPF), total palpebral fissure area (TA), upper nasal palpebral fissure area (UNA), and upper temporal palpebral fissure area (UTA) were measured. Changes of lid parameters after injection were evaluated.

Results: The average injections per each patients were 2.67, and the mean follow-up period was 150.9  85.6 days. All lid parameters improved significantly after triamcinolone injection (all p<0.05). 10 of 11 patients with congestive phase responded to triamcinolone, but 2 of 3 patients with fibrotic phase did not respond to triamcinlone. Complications associated triamcinolone injection included increased intraocular pressure (2), and mild ptosis (1).

Conclusion: Subconjunctival triamcinolone injection is a simple and effective treatment option for upper lid retraction associated with thyroid eye disease, and this treatment is more effective in congestive phase.