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.

Design: Prospective, non-comparative, interventional case series.

Participants: Eleven patients with upper scleral exposure associated with thyroid eye disease who declined conservative or conventional surgical management.

Intervention: 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.

Main Outcome Measures: 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.