Local Betamethasone Versus Triamcinolone Injection In Management of Thyroid Eye Disease-Related Upper Eyelid Retraction With Proptosis.

Purpose: To compare the efficacy of local injection of both betamethasone and triamcinolone in the management of thyroid eye disease-related upper eyelid retraction with proptosis.

Methods: This prospective, double-blind, randomized clinical trial was conducted at Assiut University Hospital, Upper Egypt in the period between December 2021 and December 2023. The study included 45 patients (77 eyes) and was divided into: A (betamethasone) group and B (triamcinolone) group. The steroid was injected peri-levator (1 ml) and retrobulbar (1.5 ml). The injection was repeated every month for up to 5 injections if there was an improvement in margin reflex distance 1 (MRD1) and Hertel measurements. The injection was stopped if measurements reached the normal value or if 2 successive injections caused no improvement. The postinjection outcome was divided into; 1) effective if measurements reached the normal (MRD1 ≤4.5 mm and Hertel ≤18 mm); 2) partially effective if measurements were improved but did not reach the normal; and 3) ineffective if there was no improvement in measurements. The follow-up ranged from 6 to 20 months.

Results: In group A, the injection was effective in 35 eyes (89.74%) and partially effective in 4 eyes (10.26%). In group B, the injection was effective in 22 eyes (57.9%), partially effective in 8 eyes (21.05%) and ineffective in 8 eyes (21.05%). The mean injection number was significantly lower in group A than in group B; 2.54 ± 0.51 versus 3.74 ± 1.18.

Conclusions: This study's results suggest that betamethasone is more effective with a small number of injections than triamcinolone in the management of thyroid eye disease-related upper eyelid retraction with proptosis.