Triamcinolone acetonide and botulinum toxin A for upper eyelid retraction in thyroid-associated ophthalmopathy

To evaluate the therapeutic effect of combining subconjunctival botulinum toxin A (BTX-A) with periorbital triamcinolone acetonide (TA) injections in treating upper eyelid retraction (UER) due to thyroid-associated ophthalmopathy (TAO). Fifty eyes with TAO-related UER were randomized into two groups. Group 1 received TA alone, while group 2 received BTX-A plus TA. Marginal reflex distance (MRD1) and graine sign (GS) were measured at baseline and post-injection intervals. Elevated intraocular pressure incidence was monitored. Group 1 showed significant MRD1 reductions at 1, 3, and 6 months (P < 0.05) and a GS increase at 3 months (P < 0.05). Group 2 exhibited quicker MRD1 reductions at 1 week, 1, 3, and 6 months (P < 0.05) and earlier GS improvements at 1 week, 1, and 3 months (P < 0.05). Group 2 had lower MRD1 and higher GS values one week post-initial injection (P < 0.001 and P = 0.013, respectively) and a lower incidence of elevated intraocular pressure compared to group 1 (P < 0.05). In a six-month study, patients treated with BTX-A and TA for TAO-related UER experienced a faster therapeutic onset and sustained efficacy with reduce the total dose of multiple local TA injections and fewer side effects like elevated intraocular pressure.The trial registration number is ChiCTR2300077958, with the date of registration being 24/11/2023 (retrospectively registered).