Effect of Intraorbital Steroid Injections on Intraocular Pressure in Thyroid Eye Disease

Vladimir S Yakopson Jacqueline R Carrasco

doi:10.4172/2167-7948.1000173

Abstract

Purpose: To study the effect of orbital steroid injections administered in the treatment of thyroid eye disease (TED) on intraocular pressure (IOP). Methods: Retrospective chart review of consecutive patients over 70 months with active thyroid eye disease (TED) seen in a referral oculoplastic practice who underwent orbital steroid injections. Results: The clinical records of 56 patients were included in the study. There were 51 females and 5 males; 43 (77%) were Caucasian; the average age was 50 years old. A mean number of 3.5 injections (range 1-12) were given per patient resulting in 91 encounters being examined. Injections consisted of dexamethasone in all cases with addition of betamethasone in 49 cases, methylprednisolone in 3 cases and triamcinolone in 3 cases. Pre-injection intraocula pressurre (IOP) was recorded in 42 instances and post-injection IOP was recorded in 26 instances. The average time interval to next follow up was 9.4 weeks and the average time interval to next injection was 17.75 weeks There was no increase in the mean pre-injection vs. post-injection IOP (short-term effect), nor in the firstrecorded vs. last recorded IOP (long-term effect). In 73 instances, subjective response to injections with respect to swelling was recorded: in 46/73 (63%) cases swelling was noted to be reduced, in 19/73 no change was recorded and a worsening of swelling was reported in 8 cases. Diplopia improved in 13 cases and worsened in 4 (n=17). Conclusions: No statistically significant rise in intraocular pressure was observed following orbital steroid injections.

Highlights

Corticosteroids are the mainstay of treatment in active thyroid eye disease (TED)
Intraorbital steroid injections are primarily used as an adjunct therapy during the active inflammatory phase of TED to decrease anterior orbital soft tissue swelling, and are occasionally used in treatment of extraocular muscle (EOM) restriction
Twenty five were excluded for the following reasons: chart not located, no injection given, injection given for reason other than TED, injection given outside study period

Summary

Introduction

Corticosteroids are the mainstay of treatment in active thyroid eye disease (TED). there is a risk of multiple systemic complications from oral and intravenous administration of steroids [1]. Intraorbital steroid injections are primarily used as an adjunct therapy during the active inflammatory phase of TED to decrease anterior orbital soft tissue swelling, and are occasionally used in treatment of extraocular muscle (EOM) restriction. The use of orbital steroid injections in the treatment of TED has a long history with the first case series reported in 1966 [2]. There is wide divergence amongst and even within various medical centers as to the use of periocular/ orbital injections in the treatment of TED [3]: some clinicians never use this mode of therapy, whereas others use this routinely. We currently use a mixture of dexamethasone (Dexamethasone Sodium Phosphage, Baxter, Deerfield, IL) and betamethasone (Celestone Soluspan Injectable Suspension, Schering-Plough, Kenilworth, NJ) to treat periorbital swelling in patients with active TED

Methods

Results

Conclusion