The Ophthalmology Unit, Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.
The Ophthalmology Department, SarawakGeneralHospital,
Kuching, Sarawak, East Malaysia.
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Subconjunctival
botox for thyroid eye disease
Photo by Professor Chua
A 41 year-old woman with controlled Graves'
disease complained of a 2-year history of ocular irritation from eyelid
retraction. The irritation was worse in the left eye than the right eye.
Examination revealed bilateral exophthalmos (L>R) and upper eyelid
retraction (L>R). The tear films are poor with puntate keratitis in both
eyes (L>R). Despite hourly use of artificial tear, the ocular irritation
remained. Her visual acuities, colour vision and intraocular pressures in
both eyes were normal. Ocular movement showed bilateral restriction of
upgaze. Orbital decompression was suggested but declined by the patient
because of the possible risk of binocular diplopia. She was also not keen
for levator recession to lower her eyelids. To give her temporary relief,
she agreed to subconjunctival injection of botox lower the left upper
eyelid.
Bilateral exophthalmos and eyelid
retraction.
Side view of the proptosis.
Subconjunctival injection of botox
into the levator aponeurosis (20 units of Botox was given,the total
volume was 0.2ml constituted by adding 1ml of 0.9% NaCl solution to
100units of Botox).
Left ptosis 48 hours after the
injection. The right eyelid was later injected with
