A single transcutaneous injection with Botox for dysthyroid lid retraction.
OBJECTIVE
To evaluate the safety and efficacy of injections with botulinum toxin type A (BTTA,Botox), given transcutaneously, in the treatment of upper lid retraction associated with thyroid eye disease (TED).


METHODS
A total of 15 patients (21 eyes) with a stable (TED) condition, and a euthyroid state, were enrolled into the study. There were 12 females and three males from ages 23 to 52 years. A single injection, at the centrally superior tarsal border transcutaneously, aiming at the levator aponeurosis and Müller muscle, was administered into each eyelid with 5-6 U of Botox. All patients were followed regularly for 4-6 months. Any complications, such as ptosis, diplopia, pain,or lid ecchymosis were recorded.


RESULTS
All patients, except one, experienced much reduction of palpebral fissure. The mean difference of MRD1 between pre- and postinjections of Botox at the first week was -3.1 mm, and the effect remained, at least, for 2 months. There were temporary complications of ptosis in three patients and vertical diplopia in two patients, lasting 3-4 weeks.


CONCLUSIONS
A single transcutaneous injection with Botox for the treatment of thyroid lid retraction is safe and effective. Some minor complications may occur, such as ptosis and diplopia; however, it may offer an alternative and temporary method for patients with dysthyroid lid retraction, who are waiting for a staged operation of either an orbital decompression or a strabismus surgery or both.
Shih
M-J
MJ
Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan.
Liao
S-L
SL
Lu
H-Y
HY
D000328:Adult; D001763:Blepharoptosis / Q000139:chemically induced; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D004172:Diplopia / Q000139:chemically induced; D005141:Eyelid Diseases / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D012018:Reflex / Q000502:physiology; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A