Hyaluronic acid gel injection for dysthyroid upper eyelid retraction in Asian patients.

PURPOSE To evaluate the role of hyaluronic acid (HA) filler injection in the management of upper eyelid retraction (UER) in thyroid eye disease (TED). METHODS Retrospective interventional series of all patients with TED who had undergone HA injection, from February 2011 to April 2013 by a single surgeon (Y-DK) in a tertiary medical institution. Outcome measures: Mean margin reflex distance 1 (MRD1) pre- and post-filler. RESULTS There was a total of 13 patients and 17 eyes included in the study. The injection dosage for 15 eyes was 0.5 ml, one patient had 0.35cc on the right eye and 0.65cc on the left eye. Mean MRD1 at presentation was 6.21 mm. There was a mean decrease in MRD1 of 2.01 mm (p < .001) at 1 month post filler, 2.06 mm (p < .001) at 6 months post filler and 2.61 mm (p < .001) at 1 year post filler. There was no correlation between pre-filler MRD1 and change in MRD1 at various time points post-filler, nor any correlation between pre-filler upper scleral show (USS) and change in USS post-filler. There was also no correlation found between clinical activity score (CAS) and change in MRD1, as well as duration of thyroid eye disease (TED) and change in MRD1. Complications included mild upper lid lumpiness on downgaze (n = 4, 23.5%) which improved but persisted with time. There were no untoward intravascular or vision-threatening complications. CONCLUSION Transconjunctival HA injection is an effective treatment option for TED-related UER in both active and inactive TED patients in an East Asian population, with a potentially long-lasting effect.

[1]  Dong Cheol Lee,et al.  Course of upper eyelid retraction in thyroid eye disease , 2019, British Journal of Ophthalmology.

[2]  S. Shen,et al.  Ethnic variation in deep lateral orbital anatomy and its implications on decompression surgery , 2019, Orbit.

[3]  R. Douglas,et al.  Non-surgical treatment for eyelid retraction in thyroid eye disease (TED) , 2017, British Journal of Ophthalmology.

[4]  Z. Joos,et al.  Peri‐levator palpebrae superioris triamcinolone injection for the treatment of thyroid eye disease‐associated upper eyelid retraction , 2017, Clinical and Experimental Ophthalmology.

[5]  R. Goldberg,et al.  The success rate of TED upper eyelid retraction reoperations , 2016, Orbit.

[6]  W. Saliba,et al.  Fornix triamcinolone injection for thyroid orbitopathy , 2015, Graefe's Archive for Clinical and Experimental Ophthalmology.

[7]  G. Sundar,et al.  Thyroid eye disease: a Southeast Asian experience , 2014, British Journal of Ophthalmology.

[8]  S. Kinoshita,et al.  Turn-over orbital septal flap and levator recession for upper-eyelid retraction secondary to thyroid eye disease , 2013, Eye.

[9]  S. Dayan,et al.  Restylane persisting in lower eyelids for 5 years , 2012, Journal of cosmetic dermatology.

[10]  W. Wiersinga.  Quality of life in Graves' ophthalmopathy. , 2012, Best practice & research. Clinical endocrinology & metabolism.

[11]  Hui Li,et al.  Repeated triamcinolone acetonide injection in the treatment of upper-lid retraction in patients with thyroid-associated ophthalmopathy. , 2012, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[12]  Young Joon Choi,et al.  Assessing Graves’ ophthalmopathy-specific quality of life in Korean patients , 2012, Eye.

[13]  T. Maalouf,et al.  [Efficacy and tolerability of highly crosslinked hyaluronic acid injections in the management of the enophthalmous orbit]. , 2012, Journal francais d'ophtalmologie.

[14]  E. J. Lee,et al.  Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections , 2012, Graefe's Archive for Clinical and Experimental Ophthalmology.

[15]  A. Shortt,et al.  Stability of Eyelid Height After Graded Anterior-Approach Lid Lowering for Dysthyroid Upper Lid Retraction , 2011, Orbit.

[16]  J. Sykes,et al.  Hyaluronic Acid Fillers: History and Overview , 2011 .

[17]  A. Bagheri,et al.  Transcutaneous Dysport Injection for Treatment of Upper Eyelid Retraction Associated with Thyroid Eye Disease , 2010, Orbit.

[18]  M. Monteiro,et al.  Comparative study of Botox® injection treatment for upper eyelid retraction with 6-month follow-up in patients with thyroid eye disease in the congestive or fibrotic stage , 2009, Eye.

[19]  J. Fezza.  Nonsurgical Treatment of Cicatricial Ectropion with Hyaluronic Acid Filler , 2008, Plastic and reconstructive surgery.

[20]  S. Chee,et al.  Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series , 2008, Eye.

[21]  R. Goldberg,et al.  Filling the Periorbital Hollows With Hyaluronic Acid Gel: Initial Experience With 244 Injections , 2006, Ophthalmic plastic and reconstructive surgery.

[22]  R. Schwarcz,et al.  Transconjunctival Müller muscle recession with levator disinsertion for correction of eyelid retraction associated with thyroid-related orbitopathy. , 2005, American journal of ophthalmology.

[23]  C. Haritoglou,et al.  Full thickness eyelid transsection (blepharotomy) for upper eyelid lengthening in lid retraction associated with Graves’ disease , 2005, British Journal of Ophthalmology.

[24]  K. Cahill,et al.  Botulinum toxin type a for dysthyroid upper eyelid retraction. , 2004 .

[25]  S. Liao,et al.  A single transcutaneous injection with Botox® for dysthyroid lid retraction , 2004, Eye.

[26]  V. Elner,et al.  Graded full-thickness anterior blepharotomy for upper eyelid retraction. , 2004, Archives of ophthalmology.

[27]  L. Tallstedt,et al.  Thyroid associated ophthalmopathy: botulinum toxin A in the treatment of upper eyelid retraction--a pilot study. , 2001, Acta ophthalmologica Scandinavica.

[28]  C. Terwee,et al.  Development of a disease specific quality of life questionnaire for patients with Graves’ ophthalmopathy: the GO-QOL , 2022 .

[29]  M. Söylev,et al.  Chemodenervation in treatment of upper eyelid retraction. , 1997, Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde.

[30]  K. Jordan,et al.  The surgical management of dysthyroid related eyelid retraction using Mersilene mesh , 1989, Eye.