Fornix triamcinolone injection for thyroid orbitopathy

Purpose: In this pilot study we aimed to examine the association between eyelid fornices triamcinolone injections and clinical activity score in patients with active thyroid orbitopathy. Methods: Adult patients aged 18 years or older, diagnosed with active thyroid orbitopathy and a clinical activity score ≥3 were recruited to this interventional prospective pilot study between 2010 and 2013. Three upper and lower fornices injections of triamcinolone acetate 20 mg (40 mg/ml) were administered at 4-week intervals. Each patient included was followed up for a period of 6 months. Clinical activity score was estimated at each monthly visit. Extraocular muscle thickness was measured by ultrasound examination at entrance and at the last visit. Results: Eleven eyes of seven patients were included in our study. Initial clinical activity score was 3.81 ± 1.80 and fell to 0.63 ± 0.72 during a 6-month follow-up. There was a significant difference in clinical activity score between the baseline examination and the following visits (p-value < 0.0001). Ultrasound examination showed a significant decrease in medial and lateral rectus muscle thickness following treatment; median difference −0.93 and −0.58, respectively (p-value < 0.005). Lid retraction was reduced by the treatment. Side effects included a transitory increase in intraocular pressure in one patient, which was controlled with topical medication. Conclusions: In this pilot study a series of three separate triamcinolone fornix injections at 4-week intervals reduces the inflammatory effects of thyroid orbitopathy, as measured by clinical activity score. The treatment was simple, effective, and safe eliminating the side effects associated with systemic corticosteroid use.