Subcutaneous Injections of Triamcinolone Acetonide for Upper Eyelid Retraction and Swelling Associated with Thyroid Eye Disease: A Retrospective Case Series Study

Overview

Journal Clin Ophthalmol

Publisher Dove Medical Press

Specialty Ophthalmology

Date 2024 Jul 29

PMID 39070106

Authors

Ai Kozaki

Rishu Inoue

Naoko Yaji

Koichi Nishiyama

Toshu Inoue

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the efficacy of subcutaneous injection of triamcinolone acetonide (SCTA) in treating upper eyelid retraction and swelling in patients with thyroid eye disease (TED).

Patients And Methods: This case series included consecutive patients (aged 16-69 years, monitored from June 2012 to December 2015) with TED-related eyelid symptom and without an enlarged extraocular muscle on magnetic resonance imaging (MRI). SCTA (0.5 mL, 40 mg/mL) was administered to target the orbital fat around the levator palpebrae superioris (LPS) muscle. Patients who did not exhibit improvement after the first trial received an additional injection. Follow-up was conducted for 12 months with 3-month intervals. Eyelid retraction, eyelid swelling, and eyelid lag were evaluated at each follow-up visit.

Results: In total, 116 eyelids of 102 patients were analyzed. SCTA led to significant improvement in 93% of eyes (108/116), disappearance of eyelid symptoms (74%, 87%, and 73% in retraction, swelling, and lag, respectively), and improvement of scores (from 1.64 to 0.12, 1.32 to 0.26, and 1.72 to 0.30, respectively). Improvement in eyelid symptoms was observed in eight eyes; however, additional steroid therapy was required in these cases due to the emergence of other extraocular muscle inflammation. Additional injection was required in 39.8% of patients. The clinical activity score was lower in the single SCTA group than in the multiple SCTA group (1.5 vs 0.9; p < 0.01). However, the levels of thyroid-stimulating hormone receptor antibody and MRI findings were not significantly different between the two groups. No elevation in intraocular pressure was observed. Eight female patients experienced menstrual disorder.

Conclusion: SCTA effectively reduced LPS muscle enlargement and fat tissue swelling in patients with TED. A single SCTA was sufficient in almost 60% of the patients; nevertheless, follow-up is necessary to detect early signs of orbital inflammation even in eyelid-symptom-improved patients.

References

Lee J, Lee H, Park M, Baek S . Subconjunctival injection of triamcinolone for the treatment of upper lid retraction associated with thyroid eye disease. J Craniofac Surg. 2012; 23(6):1755-8. DOI: 10.1097/SCS.0b013e3182646043. View

Hiromatsu Y, Sato M, Inoue Y, Koga M, Miyake I, Kameo J . Localization and clinical significance of thyrotropin receptor mRNA expression in orbital fat and eye muscle tissues from patients with thyroid-associated ophthalmopathy. Thyroid. 1996; 6(6):553-62. DOI: 10.1089/thy.1996.6.553. View

Kozaki A, Inoue R, Komoto N, Maeda T, Inoue Y, Inoue T . Proptosis in dysthyroid ophthalmopathy: a case series of 10,931 Japanese cases. Optom Vis Sci. 2010; 87(3):200-4. DOI: 10.1097/OPX.0b013e3181ce5702. View

Bartley G, Fatourechi V, Kadrmas E, Jacobsen S, Ilstrup D, Garrity J . Clinical features of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996; 121(3):284-90. DOI: 10.1016/s0002-9394(14)70276-4. View

Terwee C, Gerding M, Dekker F, Prummel M, Wiersinga W . Development of a disease specific quality of life questionnaire for patients with Graves' ophthalmopathy: the GO-QOL. Br J Ophthalmol. 1999; 82(7):773-9. PMC: 1722683. DOI: 10.1136/bjo.82.7.773. View

GAY A, Wolkstein M . Topical guanethidine therapy for endocrine lid retraction. Arch Ophthalmol. 1966; 76(3):364-7. DOI: 10.1001/archopht.1966.03850010366012. View

Bartalena L, Kahaly G, Baldeschi L, Dayan C, Eckstein A, Marcocci C . The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. Eur J Endocrinol. 2021; 185(4):G43-G67. DOI: 10.1530/EJE-21-0479. View

Ohnishi T, Noguchi S, Murakami N, Nakahara H, Hoshi H, Jinnouchi S . Levator palpebrae superioris muscle: MR evaluation of enlargement as a cause of upper eyelid retraction in Graves disease. Radiology. 1993; 188(1):115-8. DOI: 10.1148/radiology.188.1.8511284. View

Ponto K, Pitz S, Pfeiffer N, Hommel G, Weber M, Kahaly G . Quality of life and occupational disability in endocrine orbitopathy. Dtsch Arztebl Int. 2009; 106(17):283-9. PMC: 2689575. DOI: 10.3238/arztebl.2009.0283. View

10.

Kozaki A, Nakamura H, Inoue T . Clinical efficacy of transcutaneous triamcinolone acetonide injection for upper eyelid retraction and swelling in patients with thyroid eye disease. Int Med Case Rep J. 2018; 11:325-331. PMC: 6233704. DOI: 10.2147/IMCRJ.S177671. View

11.

Chee E, Chee S . Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series. Eye (Lond). 2007; 22(2):311-5. DOI: 10.1038/sj.eye.6702933. View

12.

Shih M, Liao S, Lu H . A single transcutaneous injection with Botox for dysthyroid lid retraction. Eye (Lond). 2004; 18(5):466-9. DOI: 10.1038/sj.eye.6700690. View

13.

Lee S, Rim T, Jang S, Kim C, Shin D, Lee E . Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections. Graefes Arch Clin Exp Ophthalmol. 2012; 251(1):261-70. DOI: 10.1007/s00417-012-2153-y. View

14.

Noh J, Hamada N, Inoue Y, Abe Y, Ito K . Thyroid-stimulating antibody is related to Graves' ophthalmopathy, but thyrotropin-binding inhibitor immunoglobulin is related to hyperthyroidism in patients with Graves' disease. Thyroid. 2000; 10(9):809-13. DOI: 10.1089/thy.2000.10.809. View

15.

Zang S, Ponto K, Kahaly G . Clinical review: Intravenous glucocorticoids for Graves' orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab. 2011; 96(2):320-32. DOI: 10.1210/jc.2010-1962. View

16.

Smith T, Hegedus L . Graves' Disease. N Engl J Med. 2016; 375(16):1552-1565. DOI: 10.1056/NEJMra1510030. View

17.

Xu D, Liu Y, Xu H, Li H . Repeated triamcinolone acetonide injection in the treatment of upper-lid retraction in patients with thyroid-associated ophthalmopathy. Can J Ophthalmol. 2012; 47(1):34-41. DOI: 10.1016/j.jcjo.2011.12.005. View

18.

Mukasa K, Yoshimura Noh J, Kouzaki A, Ohye H, Kunii Y, Watanabe N . TSH receptor antibody titers measured with a third-generation assay did not reflect the activity of Graves' ophthalmopathy in untreated Japanese Graves' disease patients. Endocr J. 2015; 63(2):151-7. DOI: 10.1507/endocrj.EJ15-0137. View

19.

Douglas R, Afifiyan N, Hwang C, Chong K, Haider U, Richards P . Increased generation of fibrocytes in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab. 2009; 95(1):430-8. PMC: 2805489. DOI: 10.1210/jc.2009-1614. View

20.

Kazim M, Gold K . A review of surgical techniques to correct upper eyelid retraction associated with thyroid eye disease. Curr Opin Ophthalmol. 2011; 22(5):391-3. DOI: 10.1097/ICU.0b013e3283499433. View