SUBCONJUNCTIVAL BOTULINUM TOXIN INJECTION FOR MANAGEMENT OF UPPER AND LOWER LID RETRACTION ASSOCIATED WITH THYROID OPHTHALMOPATHY

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ETEZAD RAZAVI M.; ZAREEI GHANAVATI S.; DANESHVAR KAKHKI R.

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Journal: JOURNAL OF CURRENT OPHTHALMOLOGY Year:2006 | Volume:19 | Issue:1 Page(s): 88-97

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Title

SUBCONJUNCTIVAL BOTULINUM TOXIN INJECTION FOR MANAGEMENT OF UPPER AND LOWER LID RETRACTION ASSOCIATED WITH THYROID OPHTHALMOPATHY

Author(s)

ETEZAD RAZAVI M. | ZAREEI GHANAVATI S. | DANESHVAR KAKHKI R. | Issue Writer Certificate

Keywords

UPPER LID RETRACTIONQ3

LOWER LID RETRACTIONQ3

THYROID OPHTHALMOPATHYQ3

GRAVE'S OPHTHALMOPATHYQ3

SUBCONJUNCTIVALQ4

BOTULINUM TOXINQ3

DYSPORTQ3

Abstract

Purpose: To evaluate the results and complications of SUBCONJUNCTIVAL BOTULINUM TOXIN injections in the management of thyroid associated upper and LOWER LID RETRACTION at Khatam-Al-Anbia eye hospital, Medical University of Mashhad.Patients & Methods: In this Prospective, non-comparative interventional case-series, 14 patients with lid retraction associated with thyroid eye disease were treated with one or more injections of BOTULINUM TOXIN into the proximal margin of the upper and lower tarsal plate, via a conjunctival approach. The goals of study were to reduce superior scleral show to less than 1 mm and decrease LOWER LID RETRACTION. Main outcome measures were upper and lower lid response after BOTULINUM TOXIN injection, number of injections for controlling retraction during follow up and complications.Results: Of 28 upper lids treated, 24 lids required only one treatment with achievement of less than 1mm scleral show during follow up visits. Two lids required additional injection (in one patient for initially inadequate response and in on other for recurrence during follow up).Totally, we observed treatment failure (more than 1mm scleral show after 3 upper lid injections) in two patients. Among twelve responsive patients, UPPER LID RETRACTION was successfully controlled during follow up (Mean follow up was 7.6 months). No patient with initial satisfactory response became unresponsive during the study.There was variability in the degree of reduction in lid retraction and duration of effect. It was also difficult to predict the time interval needed for re-treatment. The amount of lid lowering effect of injections varied among patients and lasted between 1 and more than 14 months (mean effect of each upper lid injection lasted 7.02 months). Mean reduction of palpebral fissure, levator function, superior scleral show and lower scleral show, were 3.28±1.80mm, 1.78±1.34mm, 2.46±1.07mm and 1.50±0.80±mm at the last visit respectively.The procedure was well tolerated. No patient had diplopia or developed new motility problems, in particular hypotropia or superior rectus underaction in follow up visits. Two patients (3 eyes) experienced visually significant ptosis or chin up position lasting after 2 and 4 weeks. We experienced increasing corneal exposure and lagophthalmos in 16 of 21 eyes with lower lid treatment. In one of these patients, corneal ulcer developed.Conclusion: SUBCONJUNCTIVAL Botulinum A toxin injection provides an effective treatment for upper eyelid retraction associated with thyroid eye disease even in patient with long standing lid retraction. The treatment safely relieved symptoms and improved eye appearance as a temporary solution. Treatment of LOWER LID RETRACTION was associated with high rate of lagophthalmos that led to corneal ulcer in one our patient. By our experience, lower lid treatment is not recommended as routine in the case of LOWER LID RETRACTION.

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APA: Copy

ETEZAD RAZAVI, M., ZAREEI GHANAVATI, S., & DANESHVAR KAKHKI, R.. (2006). SUBCONJUNCTIVAL BOTULINUM TOXIN INJECTION FOR MANAGEMENT OF UPPER AND LOWER LID RETRACTION ASSOCIATED WITH THYROID OPHTHALMOPATHY . JOURNAL OF CURRENT OPHTHALMOLOGY, 19(1), 88-97. SID. https://sid.ir/paper/53095/en

Vancouver: Copy

ETEZAD RAZAVI M., ZAREEI GHANAVATI S., DANESHVAR KAKHKI R.. SUBCONJUNCTIVAL BOTULINUM TOXIN INJECTION FOR MANAGEMENT OF UPPER AND LOWER LID RETRACTION ASSOCIATED WITH THYROID OPHTHALMOPATHY . JOURNAL OF CURRENT OPHTHALMOLOGY[Internet]. 2006;19(1):88-97. Available from: https://sid.ir/paper/53095/en

IEEE: Copy

M. ETEZAD RAZAVI, S. ZAREEI GHANAVATI, and R. DANESHVAR KAKHKI, “SUBCONJUNCTIVAL BOTULINUM TOXIN INJECTION FOR MANAGEMENT OF UPPER AND LOWER LID RETRACTION ASSOCIATED WITH THYROID OPHTHALMOPATHY ,” JOURNAL OF CURRENT OPHTHALMOLOGY, vol. 19, no. 1, pp. 88–97, 2006, [Online]. Available: https://sid.ir/paper/53095/en

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