Shih M.-J.SHU-LANG LIAOLu H.-Y.2021-09-042021-09-0420040950-222Xhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-2942689373&doi=10.1038%2fsj.eye.6700690&partnerID=40&md5=bd9acebf821635141c64a39b66846569https://scholars.lib.ntu.edu.tw/handle/123456789/581680Purpose. To evaluate the safety and efficacy of injections with botulinum toxin type A (BTTA, Botox?), given transcutaneously, in the treatment of upper lid retraction associated with thyroid eye disease (TED). Methods. A total of 15 patients (21 eyes) with a stable (TED) condition, and a euthyroid state, were enrolled into the study. There were 12 females and three males from ages 23 to 52 years. A single injection, at the centrally superior tarsal border transcutaneously, aiming at the levator aponeurosis and M?ller muscle, was administered into each eyelid with 5-6U of Botox?. All patients were followed regularly for 4-6 months. Any complications, such as ptosis, diplopia, pain, or lid ecchymosis were recorded. Results. All patients, except one, experienced much reduction of palpebral fissure. The mean difference of MRD1 between pre- and postinjections of Botox? at the first week was -3.1 mm, and the effect remained, at least, for 2 months. There were temporary complications of ptosis in three patients and vertical diplopia in two patients, lasting 3-4 weeks. Conclusions. A single transcutaneous injection with Botox? for the treatment of thyroid lid retraction is safe and effective. Some minor complications may occur, such as ptosis and diplopia; however, it may offer an alternative and temporary method for patients with dysthyroid lid retraction, who are waiting for a staged operation of either an orbital decompression or a strabismus surgery or both. ? 2004 Nature Publishing Group All rights reserved.Botulinum toxin type A; Thyroid eye disease; Upper lid retraction[SDGs]SDG3botulinum toxin A; adult; article; clinical article; controlled study; diplopia; disease activity; drug efficacy; drug safety; ecchymosis; endocrine ophthalmopathy; euthyroidism; eye pain; eyelid; female; follow up; human; male; palpebral fissure; ptosis; single drug dose; strabismus surgery; surgical technique; transdermal drug administrationjournal article10.1038/sj.eye.6700690151316752-s2.0-2942689373