Oculoplastic and Orbital Diseases Services, Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil.
Eye (Lond). 2009 Apr;23(4):767-73. doi: 10.1038/eye.2008.165. Epub 2008 Jun 6.
To compare morphometric data of the eyelid fissure and the levator muscle function (LF) before and up to 6 months after transcutaneous injection with five units of Botox in patients with upper lid retraction (ULR) from congestive or fibrotic thyroid eye disease (TED).
Twenty-four patients with ULR from TED were submitted to transcutaneous injection of 5 units (0.1 ml) of Botox in one eye only. Patients were divided into two groups: 12 with congestive-stage TED (CG), and 12 with fibrotic-stage TED (FG). Bilateral lid fissure measurements using digital imaging and computer-aided analysis were taken at baseline and at regular intervals 2 weeks, 1 month, 3 months and 6 months after unilateral Botox injection. Mean values taken at different follow-up points were compared for the two groups.
Most patients experienced marked improvement in ULR, with a mean reduction of 3.81 mm in FG and 3.05 mm in CG. The upper eyelid margin reflex distance, fissure height and total area of exposed interpalpebral fissure were significantly smaller during 1 month in CG and during 3 months in FG. Reduction in LF and in the difference between lateral and medial lid fissure measurements was observed in both groups. The treatment lasted significantly longer in FG than in CG.
A single 5-unit Botox injection improved ULR, reduced LF and produced an adequate lid contour in patients with congestive or fibrotic TED. The effect lasts longer in patients with fibrotic orbitopathy than in patients with congestive orbitopathy.
比较 5 单位肉毒毒素经皮注射治疗甲状腺相关眼病（thyroid eye disease，TED）所致上睑退缩（upper lid retraction，ULR）患者上睑提肌功能（levator muscle function，LF）和睑裂形态的变化。
24 例 TED 患者的单眼接受 5 单位（0.1ml）肉毒毒素经皮注射，根据病变处于活动期（congestive stage，CG）还是纤维增殖期（fibrotic stage，FG）分为两组，CG 组 12 例，FG 组 12 例。采用数字成像和计算机辅助分析技术测量双侧睑裂，分别在基线及注射后 2 周、1 个月、3 个月和 6 个月时随访。比较两组各随访时间点的平均值。
大部分患者 ULR 显著改善，FG 组和 CG 组的上睑缘提升高度分别平均减少 3.81mm 和 3.05mm。CG 组在 1 个月和 FG 组在 3 个月时，上睑缘位置、睑裂高度和暴露的睑裂总面积均显著减小。两组 LF 均减小，外侧和内侧睑裂高度差值减小。FG 组治疗效果持续时间明显长于 CG 组。
单次 5 单位肉毒毒素注射可改善 ULR，减少 LF，使 CG 和 FG 患者的上睑外观得到改善。FG 组的治疗效果持续时间长于 CG 组。
