Repeated Retrobulbar Injections of Triamcinolone Acetonide for Thyroid Orbitopathy

Background: Thyroid associated orbitopathy (TAO) is an autoimmune disorder. It usually occurs in association with hyperthyroidism. Systemic corticosteroids provide the mainstay treatment for patients with severe and active orbitopathy, but its benefit is associated with important side effects. Attempts to reduce the systemic effects of corticosteroid by using local steroid administration by retrobulbar injection as triamcinolone acetonide. Purpose: To identify the result of retro-bulbar triamcinolone injection in patients with thyroid associated orbitopathy. Material and Methods: Prospective non-comparative study in 20 eyes of 10 patients who had been diagnosed as thyroid associated orbitopathy during October 2008 through October 2009. The patients received retrobulbar 40mg triamcinolone treatment for each orbit weekly, totaling 4 applications. Complete Ophthalmological examination including ocular ultrasonography were performed before and after treatment. Results: Three months after treatment. Improvement of proptosis was observed in 16 eyes (80%). All patients had improvement of extraocular muscle function as demonstrated by EOM Movement. These results remained stable in the majority of patients at the 6 months follow-up period. No systemic side effects were observed. The only local sideeffect was transitory increase in intraocular pressure in one patients was controlled with topical medication. Conclusion: This preliminary study demonstrated the potential benefit of retrobulbar triamcinolone injection in cases of thyroid associated orbitopathy. Long-term study in these patients is required.