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Thyroid-associated ophthalmopathy(TAO)is an autoimmune inflammatory disease involving multiple orbital tissues with a variety of clinical manifestations, which has serious effects on the life quality of patients.Interventions of TAO mainly include medical treatment to stabilize thyroid function, reduce inflammation and regulate immune function, as well as surgical treatment to relieve ocular symptoms. Botulinum toxin type A can paralyze muscles by blocking nerve impulse conduction at the neuromuscular junction, which is of certain therapeutic value for restrictive strabismus due to extraocular muscle involvement and upper eyelid retraction due to involvements of levator palpebrae superioris and Müller's muscle in TAO patients, especially when they have surgical contraindications, lack surgical opportunity, or refuse surgery. This paper reviews the application of botulinum toxin type A in the treatment of TAO, focusing on its pharmacological mechanism, dosage, effectiveness, and possible complications when treating restrictive strabismus and upper eyelid retraction, and discussing potential therapeutic values of botulinum toxin type A for intraocular pressure elevation, glabellar frown lines and dry eye caused by extraocular muscle compression in TAO patients, in order to provide a reference for clinical intervention.
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@#AIM: To explore the clinical efficacy and prognosis of glucocorticoid combined with surgical method for TAO-related upper eyelid retraction. <p>METHODS: A total of 96 patients(146 eyes)with upper eyelid retraction who were admitted to the plastic surgery clinic and ward of our hospital from February 2014 to July 2018 were selected. According to different treatment methods, the patients were divided into GI group: 72 patients with TAO-related upper eyelid retraction treated with glucocorticoids; 72 patients with GS group: 48 patients with TAO-related upper eyelid retraction treated with glucocorticoid combined with conjunctival approach. After treatment, the upper eyelid muscle strength, the treatment effect, the height of the eyelid fissure, and the actual double eyelid width were compared between the two groups of patients.<p>RESULTS: After treatment, the patients in GI group had significant treatment effects in 32 people and 47 eyes, and the patients in the GS group had significant treatment effects in 16 and 25 eyes. The patients in the GS group had significant treatment effects in 46 cases and 71 eyes, and there were no significant treatment effects in 2 people and 3 eyes. Compared with the GS group, the treatment effect of the GS group was significantly higher than that of the GI group(<i>P</i><0.05). There was no significant difference between GS group and GI group(<i>P</i>>0.05). According to the table, before treatment, the height of the eyelid fissures in the GI group and the GS group were 11.25±1.85 and 11.31±1.46mm, and the data in the two groups were similar(<i>P</i>>0.05). The height of the eyelid fissures was 10.14±1.23mm, 3mo after treatment was 8.52±1.01mm. Compared with the GI group, the recovery of blepharoplasty was better in the GS group than in the GI group(<i>P</i><0.05). According to the table, before treatment, the upper eyelid muscle strength of the patients in the GI group and the GS group were 15.34±2.13 and 15.26±1.78mm, the data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the upper eyelid muscle strength was 15.64±1.34, 14.36±1.56mm. There was no significant difference in upper eyelid muscle between the GI group and the GS group(<i>P</i>>0.05). The results showed that before treatment, the patients with GI group and GS group actually had a double eyelid width of 5.12±1.64 and 5.16±1.48mm. The data in the two groups were similar(<i>P</i>>0.05). Three months after treatment, the double eyelid was actually The widths were 7.67±2.95 and 8.49±2.39mm, respectively. Compared with the GI group, the GI group had a better change in the double eyelid width than the GI group(<i>P</i><0.05). <p>CONCLUSION: Glucocorticoid combined with conjunctival approach Müller myectomy is better for patients with upper eyelid retraction, which can significantly improve the height of the eyelid fissure and the width of the double eyelid.
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Objective To evaluate the effect of correcting upper eyelid retraction in patients with iatrogenic ophthalmopathy by a new technique of modified transsection and longitudinal suture levator muscle prolongation treatment.Methods The traditional levator muscle flap trapezoidal incision was changed into horizontal incision,According to the amount of upper eyelid retraction we designed a transverse incision with 1 ∶ 2 in the central part of levator aponeurosis.Along the line of incision was designed transverse incision of Mulller's muscle combined with levator aponeurosis complex was designed,with longitudinal suture of incision.Results Five patients (6 eyes) with iatrogenic upper eyelid retraction were treated by this method.The follow up was performed for 3 to 12 months.All were satisfied with good cosmetic results,the degree of bilateral corneal exposure was symmetrical,with no recurrence and complications,except for 1 cases of unilateral upper eyelid retraction width slightly asymmetry.Conclusions The application of modified levator muscle prolongation treatment is not only quite simple,easy to adjust in operation,but also with reliable effect and less complication.It is effective for iatrogenic upper eyelid retraction range from mild to moderate degrees of correction.
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Objective · To improve the surgical procedure of correcting upper eyelid retraction.Methods · Patients suffering upper eyelid retraction of 2-5 mm caused by thyroid-associated ophthalmopathy were treated with modified levator lengthening technique in Shanghai Ninth People's Hospital (Shanghai Jiao Tong University School of Medicine,China) from July 2013 to December 2014.Results· Of the 34 patients underwent the modified levator lengthening surgery for upper eyelid retraction correction,there were 7 males and 27 females.After 6 months,upper eyelid retraction got fully resolved in 25 cases and partly improved in 9 cases.The palpebral fissure height demonstrated an average decrease of 3.7 mm (P=0.000).Patient's ocular discomfort such as photophobia and tearing were either cured or improved.Conclusion · Modified levator lengthening surgery can effectively correct upper eyelid retraction,improve the patient's appearance and cure their ocular discomfort.
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Thyroid associated ophthalmopathy (TAO) is often shown as upper eyelid retraction,conjunctival hyperemia and edema,proptosis,diplopia,strabismus and decreased visual acuity.It is difficult to make a certain diagnosis in the early stage of TAO.Patients suffering from TAO often have upper eyelid retraction at the early stage of disease,which affects appearance and causes feelings of discomfort and decreased visual acuity.Learning more about upper eyelid retraction contributes to the early diagnosis and treatment of TAO.Although upper eyelid retraction with TAO has distinctive manifestations,it is easy to misdiagnose.The differential diagnosis includes congenital eyelid retraction,neurological disorders,high axial myopia,glaucoma filtering bleb,and so on.Family history,clinical manifestations and TAO related examinations should also be taken into consideration.Comprehensive treatments should be adopted.Glucocorticoids and eyelid retraction surgeries are current mainstay of treatment.There are controversies on the application of glucocorticoids about the specific dosage,while agreement achieved that the cumulative dose should not be more than 8 g in one stage in order to reduce the risk of liver failure and other adverse events.Different operation methods should be chosen according to the degrees of retraction and causes of disease for each type of patients.In addition,special attentions should be paid to the decrease of muscle strength in the temporal side.Individual analysis is needed in order to diagnose and treat upper eyelid retraction with TAO.Early diagnosis and intervention can improve the appearance,visual function and quality of life of the patients.
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PURPOSE: The aim of this study is to evaluate the effects and complications of mixed injections of botulinum neurotoxin A (BoNT-A), triamcinolone acetonide, 5-fluorouracil (5-FU) in patients with Graves upper eyelid retraction. METHODS: Twenty-four eyes of 17 patients with a mean age of 43.9 years showed symptoms of Grave's upper eyelid retraction (GUER). They received mixed injections of BoNT-A 4 IU/0.1 mL, triamcinolone acetonide 4 mg/0.1 mL and 5-FU 5 mg/0.1 mL via subconjunctival injection. The response to treatment and the presence of adverse effects were followed up for 9.0 ± 6.0 months and evaluated retrospectively. RESULTS: Margin reflex distance 1 decreased significantly from 5.6 ± 1.2 mm to 4.7 ± 1.1 mm at 1 month after injection. Tarsal platform show increased significantly from 1.4 ± 1.3 mm to 1.8 ± 1.3 mm, and tear break up time increased significantly from 5.2 ± 3.1 seconds to 10.3 ± 7.8 seconds. When success was defined as the correction amount of GUER being larger than 1 mm, the success rate was 66.7%. Kaplan-Meier survival analysis showed that GUER correction effects last longer in patients with a duration of disease longer than 6 months. There were no severe adverse effects such as diplopia, blepharoptosis and intraocular pressure elevation. CONCLUSIONS: Mixed injections of BoNT-A, triamcinolone acetonide and 5-FU, which compensate the side effects of solitary injection and enhances the anti-fibrotic effect, improves the eyelid position and tear film stability in the patients with GUER. It is an effective and safe method for treating GUER with long maintenance with less adverse effects.
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Humans , Blepharoptosis , Botulinum Toxins, Type A , Diplopia , Eyelids , Fluorouracil , Injections, Intraocular , Intraocular Pressure , Reflex , Retrospective Studies , Tears , Triamcinolone Acetonide , TriamcinoloneABSTRACT
objective To explore a reasonable treatment for upper eyelid shrinking. Methods All 15 patients with upper eyelid retrac-tion were divided in group A,group B and group C. Group A with 9 eyes received botulinum toxin type A,group B with 10 eyes were corrected by central aponeurosis disinsertion,group C with 9 eyes upper eyelid were corrected by the lengthening of the levator muscle and Müller's muscle. And the data was summarized and analyzed. Results Five cases (9 eyes) with upper eyelid shrinking obviously were improved 72 h after injecting botulinum toxin type A,but the eyelids returned to previous states 4~6 months later. The shape of postoperative eyelid was good and the eyelids structure was natural in group B,recurrence was in 2 cases. Patients in group C had satisfactory results. And there was no recurrence and complications after 3~24 months of follow-up. Conclusion The three treatments have effect on upper eyelid shrinking at quiescence phase. The method of injecting botulinum toxin type A is simple,with reliable curative effect and short duration,while it was nee-ded repeated injections. The method of central aponeurosis disinsertion is simple but difficult to quantify properly. The lengthening of the leva-tor muscle is not only simple but also with reliable effect and less complications.
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PURPOSE: To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction. METHODS: Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated. RESULTS: Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean +/- standard deviation of 27.7 +/- 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 +/- 1.3 mm from 6.3 +/- 1.5 mm preoperatively to 3.2 +/- 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession. CONCLUSIONS: Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction.
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Humans , Accounting , Anesthesia, Local , Cosmetics , Eye , Eyelids , Follow-Up Studies , Graves Ophthalmopathy , Orbital Pseudotumor , Reflex , Reoperation , Retrospective StudiesABSTRACT
PURPOSE: To investigate the effectiveness of botulinum toxin injections in the management of upper eyelid retraction associated with thyroid eye disease and developed after levator resection. METHODS: Under topical anesthesia, 2.5 to 7.5 units of botulinum toxin type A were administered medially and laterally at the superior margin of the tarsal plate after everting the upper eyelid. The level of the upper eyelid was evaluated by MRD1 obtained from photographs taken during the follow-up period. RESULTS: Of 9 patients treated, 5(55.6%) experienced some improvement in the amount of lid retraction after injections and 3(33.3%) showed good results with a difference in height between the two eyelids of less than 1mm. Ptosis was developed in two patients, but was transient and improved in one month. There were no other complications such as strabismus. CONCLUSIONS: This subconjunctival method of botulinum toxin injection is easy to administer and can be used safely and repeatedly, without significant side effects, for patients who do not wish to undergo a surgical procedure or as a temporary purpose before surgery.
Subject(s)
Humans , Anesthesia , Botulinum Toxins , Botulinum Toxins, Type A , Eye Diseases , Eyelids , Follow-Up Studies , Strabismus , Thyroid GlandABSTRACT
During 1996-1997, the Pediatric Dep. of the Institute of Opthamology operated the recession of the levator muscle for the treatment of upper eyelid retraction. All 10 patients experienced the moderate retraction (2-4 mm). There was no intraoperative complication. The postoperative complication comprised relapsed retraction (3), relapsed eyelid prolapsed and eyelid fold was bigger than normal (8).