The Result of Botulinum Toxin A Injection in the Upper Eyelid Retraction of Thyroid-Associated Ophthalmopathy Patients

ABSTRACT

PURPOSE: This study is to determine the effects of botulinum toxin injection on patients who suffer from upper eyelid retraction caused by thyroid ophthalmopathy. METHODS: We injected 10-15 units botulinum toxin (Botox(R), Allergan, USA) on the upper tarsus of 12 eyes of 12 thyroid ophthalmopathy patients and compared duration of disease, clinical activity scores (CAS), intraocular pressures (mmHg), exophthalmometry (mm), upper eyelid retraction (mm), marginal reflex distance1 (MRD1, mm), levator function test (mm), lid lag (mm), limitation of ocular movement (mm), lid tension test results, phenylephrine test results, and orbital computed tomography results before and after the injection. RESULTS: The patient group with smaller-sized cross section of superior rectus/levator complex before the injection showed a greater decrease of upper eyelid retraction after the injection (p=0.04). Other clinical parameters showed no significant relations on the effect of the toxin injection. CONCLUSIONS: Botulinum toxin injection can have variable effects on the upper eyelid retraction of thyroid ophthalmopathy patients. The patients who had smaller volume of superior rectus/levator complex measured in orbital cross sections on CT, could expect good results after botulinum toxin injection.