An algorithm for Botulinum toxin A injection for upper eyelid retraction associated with thyroid eye disease:...

Area of Science:

• Ophthalmology
• Endocrinology
• Plastic Surgery

Background:

• Thyroid eye disease frequently causes upper eyelid retraction, impacting ocular aesthetics and function.
• Management of upper eyelid retraction in thyroid eye disease often requires surgical intervention.
• Botulinum toxin A offers a less invasive alternative for managing eyelid retraction.

Purpose of the Study:

• To assess the efficacy and safety of transconjunctival Botulinum toxin A injections for upper eyelid retraction in thyroid eye disease.
• To evaluate the outcomes of an algorithmic approach to dosing Botulinum toxin A.
• To document complications associated with this treatment modality.

Main Methods:

• Retrospective review of 71 eyes from 60 patients with inactive thyroid eye disease.
• Transconjunctival injection of Botulinum toxin A above the superior tarsal border using an algorithm-based dosage (2-15 units).
• Measurement of margin-reflex distance pre- and post-injection at specified intervals; recording of complications like diplopia and ptosis.

Main Results:

• Successful correction of upper eyelid retraction (normal margin-reflex distance) in 81.7% of eyes.
• Additional injections were required in 11.2% for undercorrection.
• Transient ptosis occurred in 4 eyes; upper eyelid retraction recurred after an average of 5.1 months.

Conclusions:

• Transconjunctival Botulinum toxin A injection is an effective, safe, and repeatable treatment for upper eyelid retraction in thyroid eye disease.
• The employed algorithm achieved a high success rate.
• The method is associated with few complications and offers a transient solution.