title: Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series.
abstract: OBJECTIVE
  To report the results of subconjunctival injection of triamcinolone in the treatment of thyroid eye disease-related lid retraction.
  
  
  METHODS
  Patients with either unilateral or bilateral upper lid retraction, secondary to thyroid eye disease, diagnosed during the period of February 2004 to June 2005 were recruited. An injection of 0.5 ml of triamcinolone acetonide (40 mg/ml kenalog) with 0.1 ml of 2% lignocaine was injected into the subconjunctival region of the lid between the conjunctiva and Muller's muscle under topical anaesthesia on upper lid eversion. Pre- and post-procedure measurements included lid aperture, marginal reflex distance, the amount of lagophthalmos, and intraocular pressure measurements. Photographs were also obtained before the procedure and at subsequent visits. Follow-up was done at 2 weeks, 1, 3, 6 months and at 1 year.
  
  
  RESULTS
  Three of the four patients had resolution of their upper lid retraction within 1 month of treatment, with one patient requiring a repeat triamcinolone injection. The patient who had fibrotic muscles did not respond to triamcinolone injections and required surgical correction.
  
  
  CONCLUSIONS
  Upper lid subconjunctival triamcinolone appears to be an effective treatment option in reducing lid retraction in patients with recent onset of thyroid eye disease.
authors.affiliation: Singapore National Eye Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: E
authors.initials: E
authors.lastname: Chee
authors.forename: S-P
authors.initials: SP
authors.lastname: Chee
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005141:Eyelid Diseases / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000188:drug therapy*; D006801:Humans; D007267:Injections / Q000379:methods; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide