The Results of Periocular Injections of Triamcinolone for Thyroid Orbitopathy

Bo Young Jung; Yoon Duck Kim

doi:10.3341/jkos.2007.48.9.1163

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Jung and Kim: The Results of Periocular Injections of Triamcinolone for Thyroid Orbitopathy

Original Article

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

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.9.1163

The Results of Periocular Injections of Triamcinolone for Thyroid Orbitopathy

Bo Young Jung, M.D.¹, Yoon Duck Kim, M.D.²

¹Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea

²Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan Univesity College of Medicine, Seoul, Korea

Address reprint requests to Yoon Duck Kim, M.D., Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University College of Medicine #50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-3561, Fax: 82-2-3410-0074, E-mail: ydkim@smc.samsung.co.kr

Received 8 December 2006 Accepted 27 April 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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Keywords: Periocular injection, Thyroid orbitopathy, Triamcinolone

References

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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).

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Table 1.

Summary of clinical findings

Case No.	Age (yrs)/Sex	Duration of eye Sx^∗ (mo)	Previoustherapy	Systemic steroid side effects	Thyroidstate	Thyroid therapy
1	46/M	3	IV^† steroids	Uncontrolled DM^‡	Hyper^#	Antithyroid drugs
2	54/F	3	Oral steroids	Increased body weight	Eu^∗∗	Antithyroid drugs
3	43/M	6	IV steroids	Peptic ulcer, Increased blood sugar	Eu	Antithyroid drugs
4	52/F	12	None	HTN^§	Eu	Antithyroid drugs
5	43/M	24	Oral steroids	HTN, CHF^∏	Eu	None
6	54/F	36	None	Uncountrolled DM	Hypo^††	Thyroidectomy

^∗ Sx: Symptom

^† IV: Intravenous

^‡ DM: Diabetes mellitus

^§ HTN: Hypertension,

^∏ CHF: Congestive heart failure

^# Hyperthyroid, Eu: Euthyroid

^∗∗ Eu: Euthyroid

^†† Hypo: Hypothyroid.

Table 2.

Results of periocular triamcinolone injections

Case No.	Improvement of soft tissue swelling	Improvement of proptosis	Improvement of motility	F/U (mo)	Additional therapy
1	Poor	Worsening	Poor	7	Radiation therapy
2	Good	No change	Poor	10	None
3	Poor	No change	Poor	10	Radiation therapy
4	Good	No change	Poor	2	None
5	Poor	Worsening	Poor	14	IV^∗ steroids
6	Good	Good	Poor	11	Strabismus surgery

^∗ IV: Intracvenous.

Table 3.

The changes of extraocular muscles in 4 patients

	Before injection (mean±SD) (mm)	After injection (mean±SD) (mm)
Superior muscle group^∗	5.70±1.61	6.83±1.77
Inferior rectus	5.85±1.21	5.88±1.33
Medial rectus	6.56±0.96	6.60±1.33
Lateral rectus	3.94±0.93	4.29±1.03

^∗ Superior muscle group: superior rectus muscle, levator palpebrae muscle.

p>0.05 (Wilcoxon's signed rank test).

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