title: Treatment of upper eyelid retraction associated with thyroid eye disease with subconjunctival botulinum toxin injection.
abstract: OBJECTIVE
  To study the effectiveness of botulinum toxin injections, via a subconjunctival approach, in the management of upper eyelid retraction associated with thyroid eye disease.
  
  
  METHODS
  Prospective, non-comparative, interventional case series.
  
  
  METHODS
  Eleven patients with upper scleral exposure associated with thyroid eye disease who declined conservative or conventional surgical management.
  
  
  METHODS
  One or more treatments with injections of botulinum toxin into the subconjunctival space at the superior margin of the tarsal plate, via a conjunctival approach.
  
  
  METHODS
  Upper eyelid position in relation to the upper limbus, patient satisfaction, and complications.
  
  
  RESULTS
  All patients experienced some improvement in the amount of lid retraction after injections. The amount of lid lowering varied between patients and lasted between 1 and 40 months. A lid position acceptable to the patient was obtained in 10 patients. Four patients had ptosis lasting from 1 to 3 weeks, and three patients had transient diplopia lasting 1 day to 3 weeks.
  
  
  CONCLUSIONS
  This subconjunctival method of botulinum toxin injection provides an effective treatment for upper eyelid retraction associated with thyroid eye disease that is easy to administer and well tolerated by patients with few side effects.
authors.affiliation: Department of Ophthalmology, West Norwich Hospital, Norwich, England.
authors.forename: Jimmy M
authors.initials: JM
authors.lastname: Uddin
authors.forename: Peter D
authors.initials: PD
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003228:Conjunctiva / Q000187:drug effects*; D005141:Eyelid Diseases / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A