Abstract Listings 2026

Purpose

To compare the efficacy of subconjunctival triamcinolone acetonide (TA) versus botulinum toxin A (BTX-A) injections for modulating upper eyelid retraction in thyroid eye disease (TED), using Margin Reflex Distance 1 (MRD1) as the primary outcome.

Methods

This prospective, double-blind, randomized controlled trial included 22 eyes with TED-related eyelid retraction (disease duration ≤ 18 months). Subjects were randomized to receive either subconjunctival TA or BTX-A. Clinical evaluations, including MRD1 and ocular parameters, were performed at 1 week, 1 month, and 3 months post-injection to monitor therapeutic efficacy.

Results

Twenty-two eyes were analyzed (TA: n=12; BTX-A: n=10). Baseline mean MRD1 was comparable between groups (TA: 6.04 mm; BTX-A: 6.15 mm). Both interventions achieved statistically significant MRD1 reductions at all follow-up intervals. While no significant difference in mean MRD1 change existed at 1 week or 1 month, with reductions of -0.49 mm for Triamcinolone and -0.89 mm for Botox at 1 week.The TA group demonstrated a significantly greater reduction at 3 months compared to the BTX-A group (mean difference -1.19 mm; 95% CI: -1.83 to -0.54, p≤0.001). At 3 months, the TA group showed more sustained improvement (mean reduction: -1.92 mm, p≤0.001) than the BTX-A group (mean reduction: -0.74 mm, p=0.002).

Conclusion

Both subconjunctival TA and BTX-A are safe and effective for managing upper lid retraction in TED. Our study demonstrated significant clinical improvement as measured by Marginal Reflex Distance 1 (MRD1). Although BTX-A showed early efficacy, TA provided a more durable clinical effect at 3 months. Furthermore, The subconjunctival approach is simple, well-tolerated, and cost-effective. TA remains a more cost-effective and accessible pharmacological option. we observed a low complication rate with no incidences of increased intraocular pressure, specifically within the TA group. Consequently, TA injections may substantially reduce the requirement for future eyelid-lowering surgery, although long-term follow-up remains essential to monitor sustained efficacy.

Additional Authors

↑ Back to top