Orbital Steroid Injection for Active Thyroid Ophthalmopathy

Purpose: To evaluate the effect of orbital steroid injection in patients with active thyroid ophthalmopathy resistant to or dependent on systemic steroids, or with complications related to systemic steroids. Methods: This prospective non comparative case series includes 31 eyes of 17 patients affected with active thyroid ophthalmopathy and clinical activity score 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 20 mg and dexamethasone 4 mg was injected in the upper and lower retroseptal orbital spaces 3 or 4 times at 1 month intervals. The patients were examined periodically after the injections and at least 3 months after the last injection; if the disease became quiescent, surgical procedures would be performed as needed. Results: Mean preinjection clinical activity score (CAS) was 5.2±1.3 which was improved to 1.6±1.2 after the 4th injection (p<0.001). Upper and lower lid retraction improved in 100% and 68.2% of affected eyes, lagophthalmos improved significantly in 64.3% of cases, and strabismus completely resolved in 1 of 5 affected patients and the most significant improvement observed in supraduction. Mean improvement in proptosis was 1.2±1.1 mm. Visual acuity did not significantly change after the injections. Eyelid ecchymosis and/or subconjunctival hemorrhage was seen in 6.5% of eyes and intraocular pressure rise occurred in 8.8% of eyes which responded to topical medications. Conclusion: Orbital steroid injections can be used for treatment active thyroid ophthalmopathy when the patient is resistant to or dependent on systemic steroids, or has developed complications of systemic steroids. CAS, lid retraction, lagophthalmos, ocular movements and proptosis improved after treatment, but visual acuity was unaffected.