Clinical Analysis Of Periorbital Injection Of Corticosteroid For Thyroid Associated Ophthalmopathy

ObjectiveTo evaluate the efficiency and the quality of life of periorbital injection of triamcinolone acetonide(TA)for treating the patient of mild to moderate thyroidassociated ophthalmopathy(TAO).MethodA total of 47 eyes of 36 patients who underwent periorbital TA injection for TAO in Second Hospital of Jilin University from September 2018 to December 2020 were reviewed.The patients were divided into the following two groups for data collection and analysis according to their symptoms and injection sites.For group A,25 patients with 29 eyes,whose main symptoms were upper eyelid retraction and orbital CT showed significant thickening of the superior rectus muscle and levator palpebrae superioris,received transconjunctival TA injection and periorbital injection(40mg)once a month.According to the recovery of upper eyelid retraction,the patients were treated for 2 to 5 times.For group B,11 patients with18 eyes,whose main symptoms were exophthalmos,diplopia and thick inferior rectus muscle showed by orbital CT,treated by periorbital injection(40mg)on inferior rectus muscle once a month for 2 to 5 times.ResultAfter treatment with corticosteroid injection,CAS score,palpebral fissure height,the degree of exophthalmos and volume of superior rectus muscle and levator palpebrae superioris of 25 patients(29 eyes)in group A decreased significantly compared with those before treatment,and the difference was with a statistical significance(P<0.05).A total of 9 patients had diplopia before treatment,while the symptoms of diplopia relieved completely in 5 patients after treatment,and 4 patients showed obvious improvement in diplopia.For group B including 18 eyes of 11 patients had a significant decline in CAS score and volume of inferior rectus muscle,with statistical significance(P<0.05).The degree of exophthalmos decreased compared with that before treatment,but the difference was not statistically significant(P>0.05).There were 8 patients suffered from diplopia in group B,while the symptoms improved in 7 patients.Only 1 patient had no change in diplopia.Among all 36 patients,13 of them were in depression and 4 of them were in anxiety before treatment.The quality of life was impaired for the untreated mild to moderate TAO patients.Diplopia was a correlate of the QOL scores for the visual functioning subscale.The QOL scores for the social function subscale were correlated with upper eyelid retraction.The treatment of periorbital injection of TA can significantly improve the quality of life for TAO patients.The scores of GO-QOL were increased with statistically significance(P>0.05).ConclusionPeriorbital injection of TA can effectively relieve the symptoms of upper eyelid retraction,exophthalmos,diplopia,reduce extraocular muscle volume and CAS score.Early and timely treatment can effectively improve the quality of life of patients suffered mild to moderate TAO.