J Korean Ophthalmol Soc.  2007 Sep;48(9):1163-1169.

The Results of Periocular Injections of Triamcinolone for Thyroid Orbitopathy

• Jung BY
• Kim YD

Abstract

PURPOSE: The aim of this study is to evaluate the effects and complications of periocular injections of triamcinolone acetonide in patients with thyroid orbitopathy who could not tolerate systemic corticosteroid therapy.
METHODS
Six patients with a mean age of 48.7 years showed symptoms of severe acute thyroid orbitopathy. They received four doses of 20 mg of triamcinolone acetonide via periocular injection into the inferotemporal orbital quadrant every 2 weeks. The response to treatment and the presence of adverse effects were evaluated retrospectively.
RESULTS
Three of six patients (50%) showed significant improvement in soft tissue swelling in both eyes. Only one patient (17%) showed improvement of proptosis. No patients showed improvement in diplopia and ocular motility. The mean thickness of the extraocular muscles measured by CT scan remained unchanged. Compressive optic neuropathy developed in one patient and resolved after intravenous high-dose steroid treatment. Two patients received radiation therapy for resistant inflammatory symptoms. One patient underwent extraocular muscle surgery. In one patient, there was no adverse effect at the injection site, except for a foreign body granuloma.
CONCLUSIONS
Periocular triamcinolone injection could be effective for patients with thyroid orbitopathy in the acute inflammatory phase in reducing soft tissue swelling. The procedure showed no significant effect on exophthalmos or ocular motility.

Keyword

Periocular injection; Thyroid orbitopathy; Triamcinolone

MeSH Terms

Diplopia
Exophthalmos
Granuloma, Foreign-Body
Humans
Injections, Intraocular*
Muscles
Optic Nerve Diseases
Orbit
Retrospective Studies
Thyroid Gland*
Tomography, X-Ray Computed
Triamcinolone Acetonide
Triamcinolone*
Triamcinolone
Triamcinolone Acetonide

Figure

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  Figure 1. Using a 26 gauge, half-inch disposable needle (A), the injection of triamcinolone acetonide of 20 mg was placed in the inferotemporal quadrant of the orbit through the lower eyelid (B).

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  Figure 2. Case 6. Facial photograph shows lid swelling, proptosis, hypertropia in primary gaze (A) and upgaze (B). Lid swelling, proptosis improved after periocular triamcinolone injection and ocular position was orthophoric after bilateral superior rectus recession in primary gaze (C) and upgaze (D).

Reference

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