Triamcinolone Acetonide and Botulinum Toxin A in the Treatment of Upper Eyelid Retraction in Thyroid-Associated Ophthalmopathy: A Clinical Study

Abstract

Abstract Purpose To observe the therapeutic effect of subconjunctival injection of botulinum toxin A (BTX-A) combined with periorbital injection of triamcinolone acetonide (TA) in the treatment of upper eyelid retraction (UER) caused by thyroid-associated ophthalmopathy (TAO). Methods Fifty eyes diagnosed with TAO-associated UER were divided into two groups. Group 1 received TA periorbital injection, while group 2 received BTX-A subconjunctival injection combined with TA periorbital injection. Marginal reflex distance (MRD1) and graine sign (GS) were assessed at baseline and at various time points post-injection. The incidence of elevated intraocular pressure was also observed. Results Group 1 showed significant decrease in MRD1 at 1, 3, and 6 months post-injection (P < 0.05) and increase in GS at 3 months post-injection (P < 0.05). Group 2 showed significant decrease in MRD1 at 1w, 1, 3, and 6 months post-injection (P < 0.05) and increase in GS at 1w, 1, and 3 months post-injection (P < 0.05). After one week of the first injection, group 2 had lower MRD1 and higher GS values than group 1 (P < 0.001 and P = 0.013, respectively). The incidence of elevated IOP was significantly lower in group 2 than in group 1 (P < 0.05). Conclusion In a six-month study, patients with TAO related UER treated with BTX-A and TA demonstrated a faster onset of therapeutic effect compared to those treated with TA alone. This combined treatment approach sustained stable efficacy with a reduced dosage of local steroid and a lower incidence of intraocular pressure elevation. Trial registration number: ChiCTR2300077958