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O. Galatoire, R. Migliardi, F. Metge, S. Morax; Treatment of Upper Eyelid Retraction With Botulinum Toxin Injection in Grave’s Disease . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2825.
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Purpose: To evaluate the effectiveness of subconjunctival injections of botulinum toxin (BT) in the treatment of upper eyelid retraction associated with Grave’s disease Methods: A prospective, interventional study was conducted at the Rothschild Foundation. Seven patients with upper scleral exposure were treated by subconjunctival BT injection. All patients were euthyroid or stable on treatment for at least 3 months at the time of the enrolment. Patients underwent full ocular examination, orthoptic assessment. BT type A was administered by anesthetizing the eye with topical anesthetic and then everting the upper lid. Two injections were applied, medially and laterally. Doses of 5, 7.5 and 10 U were administered depending on the severity of the lid retraction Results: All patients experienced improvement in the amount of lid retraction after injection. The amount of lid lowering varied between patients and lasted between 2 and 5 months. The maximum effect was achieved 1 month after the injection. Three patients required several injections. The improvement was correlated with the entity of the retraction (minor retraction better result). No complications as ptosis, or motility defect were noted. Conclusions: The subconjunctival injection of BT provides an effective treatment for dystiroid upper eyelid retraction that is easy to administer and well tolerated by patients. Larger studies are required to asses the durability and evolution of this treatment.
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