title: A single transcutaneous injection with Botox for dysthyroid lid retraction.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Shih
authors.forename: S-L
authors.initials: SL
authors.lastname: Liao
authors.forename: H-Y
authors.initials: HY
authors.lastname: Lu
mesh_terms: 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
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A