| Objective: To evaluate the efficacy and safety of repeated subconjunctival injections of triamcinolone in the treatment of upper lid retraction (ULR) with thyroid associated ophthalmopathy (TAO).
Methods: 21 patients were enrolled in the study. Subconjunctival triamcinolone acetonide was injected into each everted lid (35 eyes), with four doses of 20mg at 1-month intervals. After the treatment, eyes were divided into two groups: reponse and non-response based on the improvement of margin reflex distance. The patients were followed up regularly. Complications were recorded.
Results: Mean rate of effectiveness was 68.6%. Mean improvement of upper lid retraction was 2.31mm (0-7mm). The margin reflex distance was significantly smaller at 1 month after initiation of the treatment and improved gradually until it went into a steady state approximately 2 months later. Mean lid retraction time before treatment was 4.58 months in the response group, versus 9.91 months in the non-response group of eyes. In the eyes of presentation of upper lid retraction up to 6 months, the response rate was 83.3%, while it was 36.4% when lid retraction developed greater than 6 months. These values showed statistical significance. Muscle thickness of the levator/superior rectus complex was significantly reduced after treatment in the response group (5.13±0.85mm at last follow-up versus 5.69±0.93mm at baseline). Complications included elevation of intra-ocular pressure in 7 eyes (20%), all of which were controlled with topical anti-glaucomatous drugs. Menstrual cycle disturbance developed in 3 patients (14.3%), while moon face developed in 2 patients (9.5%).
Conclusions: Repeated subconjunctival injection of triamcinolone is an effective and safe treatment for upper lid retraction due to thyroid associated ophthalmopathy, especially in patients with recent onset of thyroid associated ophthalmopathy. | 
