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Abstract
Objective To observe the clinical efficacy of periocular injection of triamcinolone acetonide (TA) and subpalpebral injection of botulinum toxin type A (BTXA) for the treatment of thyroid-associated ophthalmopathy (TAO) with mild unilateral upper eyelid retraction. Method This was a prospective randomized controlled study. A total of 68 cases of stable thyroid-associated ophthalmopathy with mild upper eyelid retraction were collected at Hankou Aier Eye Hospital from Jan. 2015 to Dec. 2018 and randomly divided into two groups. Group A contained 33 patients who were administered TA by periocular injection once every 3 weeks for a total of 3 times. Group B contained 35 patients who were given a single subpalpebral administration of BTXA. The efficacy in the two groups was observed. Results Compared with the two groups, the effective rate in both groups was 100% at 1 week and 1 month after treatment. The effective rate of Group A remained 100% at 3 months after treatment, and that of Group B decreased to 88.6%. At 1 week after treatment, the degree of correction in Group B was greater than that in Group A (p < 0.001). At 1 month after treatment, it was not significantly different between the two groups (p > >>0.05). At 3 months after treatment, it was less in Group B than in Group A (p < 0.001). In Group A, there was one case of transient amaurosis, two cases of periorbital hemorrhage and swelling, and one mild case of sunken eyes. In Group B, four cases experienced recurrence after 3 months. Conclusion Periocular injection of TA and subpalpebral injection of BTXA offer definite therapeutic efficacy for mild upper eyelid retraction associated with thyroid disease. The former has a long treatment period, large procedural risks, and stable efficacy. The latter is a simple procedure with a short treatment period but can easily recur.
Highlights
The initial symptom in 90% of thyroid-associated ophthalmopathy (TAO) cases is upper eyelid retraction [1, 2], a symptom which causes patients to appear as if glaring straightforward
There was no significant difference in age, eyelid retraction, Clinical activity score (CAS) score, intraocular pressure (IOP), and thyroid function index (FT3, FT4, TSH) between the two groups, which was comparable
As the most common and earliest symptom of TAO, upper eyelid retraction is a frequent cause of outpatient visits
Summary
The initial symptom in 90% of TAO cases is upper eyelid retraction [1, 2], a symptom which causes patients to appear as if glaring straightforward. In the case of patients with mild eyelid retraction, glucocorticoids and BTXA are the principal drugs used for nonsurgical treatment. Periocular injection of TA is commonly used to control ocular symptoms in active TAO [5], but recent literature rarely focuses on upper eyelid retraction [6]. Wei et al [10] used percutaneous injection of BTXA into the levator palpebrae superioris muscle to treat different degrees of TAO-associated upper eyelid retraction and achieved good results. This study selected two groups of TAO patients with mild eyelid retraction, using either periocular injection of TA or subpalpebral injection of BTXA into levator palpebrae superioris, achieving good results
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