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Bagheri A, Abbaszadeh M, Yazdani S. Intraorbital Steroid Injection for Active Thyroid Ophthalmopathy. JOVR [Internet]. 2020Feb.3 [cited 2024Apr.18];15(1):69–77. Available from: https://knepublishing.com/index.php/JOVR/article/view/5948

https://doi.org/10.18502/jovr.v15i1.5948

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authors

  • Abbas Bagheri

    Abbas Bagheri

    Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mohammad Abbaszadeh

    Mohammad Abbaszadeh

    Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Shahin Yazdani

    Shahin Yazdani

    Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Published Date

  • Feb 3, 2020
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Intraorbital Steroid Injection for Active Thyroid Ophthalmopathy

Journal of Ophthalmic and Vision Research (JOVR) / January–March 2020, Volume 15, Issue 1 / Pages 69–77

Abstract

Purpose: To evaluate the effect of orbital steroid injections in patients with active thyroid ophthalmopathy resistant to or dependent on systemic steroids, or with complications related to systemic steroid use.


Methods: This prospective non-comparative case series includes 31 eyes of 17 patients with active thyroid ophthalmopathy and clinical activity score (CAS) of 3 or more, without compressive optic neuropathy or overt exposure keratopathy. All subjects had a history of previous systemic steroid use (with steroid resistance or dependence) or had developed complications related to steroids. A combination of steroids including triamcinolone acetonide 20 mg and dexamethasone 4 mg was injected in the upper and lower retroseptal orbital spaces three or four times at one-month intervals. The patients were examined periodically after each injection and at least three months after the last injection.


Results: Mean pre-injection CAS was 5.2 ± 1.3 which was improved to 1.6 ± 1 after the fourth injection (P < 0.001). Upper and lower lid retraction improved in 100% and 68.2% of the affected eyes, respectively. Strabismus completely resolved in one of five affected patients and the most significant improvement was observed in supraduction. Mean improvement in exophthalmos was 1.2 ± 1.1 mm. Visual acuity did not significantly change after the injections. Eyelid ecchymosis and/or subconjunctival hemorrhage was observed in 7.1% and intraocular pressure rise occurred in 8.8% of eyes.


Conclusion: Orbital steroid injections can be used for the treatment of active thyroid ophthalmopathy when the patient is resistant to or dependent on systemic steroids or has developed complications of systemic steroids.

Keywords:

Graves, Lid Retraction, Orbital Inflammation, Proptosis, Steroid Injection

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