Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Botulinum Toxin Injection - a Treatment of Upper Lid Retraction in Thyroid Eye Disease

Dintelmann T., Sold J. 
Dept. of Ophthalmology, Wuerzburg University

Purpose: Upper lid retraction associated with thyroid eye disease may result in conjunctival and corneal exposure as well as being an aesthetical problem. We evaluated the effect of botulinum toxin injections in order to lower the upper lid.
Method: 13 eyes of 8 female patients presenting with scleral exposure aged 28-51 years were included in this prospective study. We injected 5-15 IE botulinum toxin A (Botox®) transconjunctivally into the levator muscle. We evaluated eye lid position, negative side effects and patient satisfaction.
Results: 9 of 13 eyes showed an improvement of lid retraction, the amount of lowering of the lid varied between 1 and 4 mm. In 7 eyes the limbus was covered by the lid at the follow-up 4 weeks after the injection. Diplopia did not occur and tear production was not influenced. Two eyes had a transient ptosis. In 9 eyes lid lag developed or increased by 0.5 to 2 mm. Two eyes were reinjected after 4 weeks, two eyes underwent lid surgery. 5 of 8 patients were satisfied with the result.
Conclusions: Botulinum toxin A injection provides an effective treatment especially in mild lid retraction and patients declining surgery. Severe side effects are few and self-limiting.

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