Objective To evaluate the effect of triamcinolone orbital injection combined with dexamethasone in treatment of the patients with the grade Ⅳ of thyriod associated ophthalmopathy. Methods NOSPEVS Ⅳ grade of 90 patients were randomly divided into three groups,Group A,orbital injection of triamcinolone combind with dexamethasone, Croup B,simple injection of triamcinolone,Group C,oral prednisone therapy for half a year. To review each record of visual acuity intraocular pressure palpebral fissure size, upper eyelid drop late exophthalmos eye movement and so on every 4 weeks and follow-up for one year. Results Group A and group B of exophthalmos and eye movement improved obviously,however,Group C with poor efficacy and more side effects,and Group A in 3 groups was the fastest with least number of injections and which improved eye symptons significantly with fewer complications. Conclusion Orbital injection of triamcinolone combined with dexamethasone could be more rapid and effective than a simple injection of triamcinolone or oral prednisone to improve symptoms and signs in thyroid ophthalmopathy.