title: Treatment of pseudoptosis secondary to aberrant regeneration of the facial nerve with botulinum toxin type A.
abstract: OBJECTIVE
  To report on low-dose minimal injection treatment using botulinum toxin A for pseudoptosis secondary to aberrant facial nerve regeneration.
  
  
  METHODS
  A retrospective chart review was carried out on 16 consecutive patients with pseudoptosis secondary to aberrant facial nerve regeneration who received botulinum toxin A injections.
  
  
  RESULTS
  Study patients include 6 men and 10 women with median age of 65 years (range 34-78). Etiology of facial nerve palsy included Bell palsy (11), surgical injury (2), trauma (2), and Ramsay-Hunt syndrome (1). Mean duration of facial nerve palsy was 8.5 years (1.1-30). Mean duration of pseudoptosis was 6.8 years (0.5-29). Botulinum toxin A (Botox; Allergan) injections were given in the medial and lateral pretarsal upper eyelid orbicularis oculi with some patients also receiving a central and/or additional lateral injection. Mean number of injections was 2.6 (2-4). Mean total dose was 10.3 units (5-20). Subjective improvement of symptoms at follow up was noted in all cases. Margin reflex distance in all patients showed statistically significant (p < 0.001) mean improvement of 1.6 mm (0.5-2.5) during orbicularis oris contracture. No side effects were reported, and all patients desired repeat injections. Repeat injection was performed at 3- to 6-month intervals, with most patients (12) returning every 3 months. Mean follow up was 12.2 months (3-61).
  
  
  CONCLUSIONS
  Using low doses of carefully injected botulinum toxin A into the upper eyelid can provide safe and successful treatment of pseudoptosis due to aberrant facial nerve regeneration.
authors: Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.
authors: Elaine R
authors: ER
authors: McElhinny
authors: Isaac
authors: I
authors: Reich
authors: Benjamin
authors: B
authors: Burt
authors: Ronald
authors: R
authors: Mancini
authors: Edward J
authors: EJ
authors: Wladis
authors: Vikram D
authors: VD
authors: Durairaj
authors: Roman
authors: R
authors: Shinder
mesh_terms: D000328:Adult; D000368:Aged; D001763:Blepharoptosis / Q000188:drug therapy* / Q000209:etiology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005152:Facial Muscles / Q000294:innervation*; D005154:Facial Nerve / Q000002:abnormalities*; D005158:Facial Paralysis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D046608:Synkinesis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A