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

Objective: To evaluate the efficacy and safety of repeated subconjunctival injections of triamcinolone in the treatment of upper-lid retraction with thyroid-associated ophthalmopathy. Design: Interventional controlled retrospective clinical study. Participants: We studied 23 eyes in 15 patients as the nontreatment control group and 35 eyes in 21 patients as the treatment group. Methods: In the treatment group, triamcinolone acetonide was subconjunctivally injected into each lid as 4 doses of 20 mg at 1-month intervals. After the treatment, the eyes were divided into 2 groups, response and nonresponse, based on the improvement in margin reflex distance. The eyes of the nontreatment group received no medicine. The eyes were examined regularly. Results: The rate of spontaneous improvement in the nontreatment group was 17.4%. The mean rate of effectiveness was 68.6%. The improvement of upper-lid retraction was 2.31 mm (0 to 7mm). The margin reflex distance was significantly smaller at 1 month after the initiation of treatment. Mean lid retraction time before treatment was 4.58 months in the response group versus 9.91 months in the nonresponse group. In the eyes presenting upper-lid retraction up to 6 months before treatment was initiated, the response rate was 83.3%. The response rate was only 36.4% when lid retraction developed more than 6 months before the procedure. The muscle thickness of the levator/superior rectus complex was significantly reduced after treatment in the response group (5.13 +/- 0.85 mm at last follow-up vs. 5.69 +/- 0.93 mm at baseline). Conclusions: Repeated subconjunctival injection of triamcinolone is an effective and safe treatment for upper-lid retraction due to thyroid-associated ophthalmopathy.