title: Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm.
abstract: Although the beneficial effect of subcutaneous injections of botulinum toxin type A (BTX-A) is well known in both blepharospasm and hemifacial spasm, the position of the injection sites around the orbicularis oculi may influence the effectiveness and side effects. Here we report results of preseptal and pretarsal BTX-A injections in 53 patients (25 blepharospasm and 28 hemifacial spasm) in whom we used both injection techniques successively. Pretarsal injections were used in 102 out of 186 treatments in blepharospasm group and in 84 out of 202 treatments in hemifacial spasm group. Pretarsal BTX-A treatment produced significantly higher response rate and longer duration of maximum response in both patient groups. This technique was also associated with a lower frequency of major side effects such asptosis. We concluded that injections of BTX-A into the pretarsal, rather than the preseptal portion of the orbicularis oculiis more effective for treatment of involuntary eyelid closure due to contractions of this muscle.
authors.affiliation: Dokuz Eylül Universitesi, Tip Fakültesi, Nöroloji Klinigi, Inciralti Izmir, Turkey. raif.cakmur@deu.edu.tr
authors.forename: Raif
authors.initials: R
authors.lastname: Cakmur
authors.forename: Vesile
authors.initials: V
authors.lastname: Ozturk
authors.forename: Fatma
authors.initials: F
authors.lastname: Uzunel
authors.forename: Beril
authors.initials: B
authors.lastname: Donmez
authors.forename: Fethi
authors.initials: F
authors.lastname: Idiman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000139:chemically induced / Q000503:physiopathology; D001764:Blepharospasm / Q000188:drug therapy* / Q000503:physiopathology; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D004333:Drug Administration Routes; D005143:Eyelids / Q000187:drug effects* / Q000294:innervation / Q000503:physiopathology; D005152:Facial Muscles / Q000187:drug effects* / Q000294:innervation / Q000503:physiopathology; D005260:Female; D019569:Hemifacial Spasm / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects / Q000502:physiology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010146:Pain / Q000139:chemically induced / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A