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Non-surgical treatment for eyelid retraction in thyroid eye disease (TED)
  1. Ana Beatriz Diniz Grisolia1,
  2. Ricardo Christopher Couso2,
  3. Suzana Matayoshi3,
  4. Raymond S Douglas4,
  5. César Augusto Briceño2
  1. 1 Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  3. 3 Division of Ophthalmology, University of São Paulo Medicine School, São Paulo, Brazil
  4. 4 Orbital and Thyroid Eye Disease Program, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr César Augusto Briceño, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; cesar.briceno{at}


Thyroid eye disease (TED) is an autoimmune condition with an unpredictable course that may lead to permanent facial disfigurement. Eyelid retraction is one of the most common findings, and frequently demands attention due to ocular exposure and impaired cosmesis. Surgical treatment remains the most effective option, but there is a role for temporary corrections during the active phase of the disease, as well as in patients who are poor surgical candidates. The aim of this review is to describe the non-surgical modalities currently available for treatment of eyelid malposition in TED. The authors have focused on the use of hyaluronic acid, triamcinolone injections and botulinum toxin type A as non-surgical treatment alternatives, paying special attention to dosing, technique, efficacy and duration of effect. Non-surgical treatment modalities may represent viable in cases where surgical correction is not an option. Although temporary, these modalities appear to be beneficial for ocular exposure remediation, improving quality of life and broadening our therapeutic arsenal.

  • thyroid eye disease
  • TED
  • graves’ disease
  • eyelid retraction
  • lagophthalmos
  • ocular exposure
  • proptosis
  • non-surgical treatment
  • minimally invasive
  • hyaluronic acid
  • botulinum toxin
  • triamcinolone

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  • Contributors All authors contributed to the manuscript as follows: Conception, design and acquisition of data: ADG, RSD, SM, CAB. Analysis and interpretation of data: ADG, RCC, CAB. Drafting the article: ADG, RCC. Revising the manuscript critically for important intellectual content: CAB. Provision of patient photographs: RSD, SM. Final approval of the manuscript: All authors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.