Transconjunctival Triamcinolone Injection for Upper Lid Retraction in Thyroid Eye Disease-A New Injection Method

Purpose: To evaluate the role of transconjunctival triamcinolone acetonide (TA) injection in the management of upper eyelid retraction in thyroid eye disease. Methods: Retrospective interventional review of all patients who underwent transconjunctival TA injection (40mg/mL) for thyroid eye disease-related upper eyelid retraction from January 2010 to December 2016 in a single tertiary institution. The present study comprised 2 groups: Patients receiving only TA injection (group 1), and patients receiving both TA injection and other immunosuppressive therapy (group 2). Results: There were a total of 99 patients and 135 eyes. Group 1 comprised of 36 eyes (26.7%), while group 2 comprised 99 (73.3%). Normalization or improvement of margin reflex distance 1 was seen in 77.4% and 97.2% of group 1 patients at early and late review, respectively, and 77.6% and 87.8% of group 2, respectively. Absence or improvement in International Thyroid Eye Disease Society inflammatory index was seen in 83.9% and 86.1% of group 1 at early and late review, respectively, and 71.9% and 76.8% of group 2, respectively. Both active (73.7%) and inactive (79.3%) groups showed good early success for improvement in margin reflex distance 1, with increased late success and no significant difference between the groups. For International Thyroid Eye Disease Society inflammatory index, the active group had better early and late success than the inactive group, with the difference being significant (P = 0.002) for late success. Conclusions: Transconjunctival TA injection is an effective treatment option for thyroid eye disease-related upper eyelid retraction, as a primary and adjunctive treatment, in both active and inactive thyroid eye disease patients.