Botulinum toxin-A-induced protective ptosis in the treatment of lagophthalmos associated with facial paralysis.
OBJECTIVE
To evaluate the safety and efficacy of the protective ptosis created by botulinum neurotoxin type-A in lagophthalmos cases due to peripheral facial paralysis.


METHODS
Protective ptosis was induced by 7.5 U botulinum neurotoxin type-A injection into levator muscles in 15 patients with peripheral facial paralysis and lagophthalmos. Its efficacy and safety were evaluated prospectively. Complete ophthalmological examinations were performed before and after injections; interpalpebral fissure, upper eyelid margin reflex distance, and levator muscle function were measured. In control visits, degree and duration of ptosis and side effects of the drug were evaluated.


RESULTS
The mean age of the patients was 55 ± 14.28 years (22-78 years). Ptosis created by botulinum neurotoxin type-A injection was severe in 12 patients (80%), moderate in 2 patients (13.3%), and mild in 1 patient (6.7%). The effect of botulinum neurotoxin type-A began in 2.33 ± 1.44 days and peaked in 5.73 ± 2.63 days. No patient needed a second injection. The mean duration for ptosis was 10.53 ± 2.89 weeks. After development of ptosis, statistically significant improvement in corneal symptoms (p < 0.01) and decrease in daily artificial tear requirement (p < 0.01) were detected. Local or systemic side effects were not observed in any of the patients.


CONCLUSIONS
In patients with peripheral facial paralysis and lagophthalmos, protective ptosis created by botulinum neurotoxin type-A injection into the levator muscle is a reliable and effective technique for the protection of the ocular surface and treatment of existing corneal complications. It represents an alternative treatment modality in cases requiring surgery.
Ondokuz Mayıs University, School of Medicine, Department of Ophthalmology, SAMSUN, Turkey. drozlem38@hotmail.com
Ozlem Eşki
OE
Yücel
Nurşen
N
Artürk
D000328:Adult; D000368:Aged; D001763:Blepharoptosis / Q000139:chemically induced*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005141:Eyelid Diseases / Q000188:drug therapy*; D005158:Facial Paralysis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007634:Keratitis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D009801:Oculomotor Muscles / Q000187:drug effects*; D055815:Young Adult
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A