Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series

PURPOSE: To report the results of subconjunctival injection of triamcinolone in the treatment of thyroid eye disease-related lid retraction. INTERVENTION: 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. CONCLUSION: Upper lid subconjunctival triamcinolone appears to be an effective treatment option in reducing lid retraction in patients with recent onset of thyroid eye disease.