Treatment of upper eyelid retraction associated with thyroid eye disease with subconjunctival botulinum toxin injection.
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.
Uddin
Jimmy M
JM
Department of Ophthalmology, West Norwich Hospital, Norwich, England.
Davies
Peter D
PD
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
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A