Riolan's muscle: Action and indications for botulinum toxin injection

Mackie, I A

doi:10.1038/eye.2000.86

Cited by 22 publications

(29 citation statements)

References 6 publications

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“…15 Patients who return with a ptosis may have either been over-treated with toxin producing a paralysis of the levator palpebrae superioris, or they may have undertreated pretarsal blepharospasm ( Figure 2). A history of intermittent ptosis suggests pretarsal spasm; however a constant ptosis may be due to either levator palpebrae superioris weakening due to spill-over of adjacent botulinum toxin, or spasm of the pretarsal orbicularis oculi, [16][17][18][19] which can be treated with pretarsal injections of botulinum toxin. 19,20 These patients are given a further injection of pretarsal toxin and reviewed 1 week later.…”

Section: Management Protocolmentioning

confidence: 99%

“…A history of intermittent ptosis suggests pretarsal spasm; however a constant ptosis may be due to either levator palpebrae superioris weakening due to spill-over of adjacent botulinum toxin, or spasm of the pretarsal orbicularis oculi, [16][17][18][19] which can be treated with pretarsal injections of botulinum toxin. 19,20 These patients are given a further injection of pretarsal toxin and reviewed 1 week later. The pretarsal injections are given as close to the lid margin as possible as recommended by Mackie 19 for the control of Riolan's muscle.…”

Section: Management Protocolmentioning

confidence: 99%

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Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

Ortisi

Henderson

Bunce

et al. 2006

Eye

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Purpose To evaluate a protocol for the treatment of facial dystonias. Method A retrospective noncomparative interventional case series of all patients who attended a specialised tertiary referral clinic between January 2000 and January 2003. At the start of treatment, patients were seen and treated at weekly intervals until their symptoms were controlled or they developed complications. The sum of the weekly doses was taken as the individual patient dose and then given at 3-4 monthly intervals as required for the individual patient. Refractory cases of spasm underwent orbicularis muscle reduction. Pretarsal spasm was treated with pretarsal botulinum toxin. If the spasm was relieved but the patient could not open their eyelids, a trial of ptosis props was undertaken and the toxin injections continued, before considering a brow suspension. If patients could not see because of a spastic Bell's phenomenon, they were given centrally acting systemic medication. Results Of 182 new patients, 63 (35%) required two or more sets of injections to titrate their optimum dose of toxin. Symptoms improved in 169 patients (93%). Of a total 332 new patients and follow-up patients, 47 (14%) underwent surgery during their management, 36 protractor myectomy, and 13 brow suspension. Protractor myectomy improved symptoms in 23 (64%). Brow suspension improved symptoms in 12 patients (92%). Conclusions The dose of botulinum toxin can be titrated to the individual patient, and the refractory cases managed satisfactorily if a logical protocol is followed. Eye (2006) 20, 916-922.

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Section: Management Protocolmentioning

confidence: 99%

Section: Management Protocolmentioning

confidence: 99%

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

Ortisi

Henderson

Bunce

et al. 2006

Eye

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“…As drogas foram utilizadas na região superior do supercí-lio. Porém, também foi sugerida a injeção pré-tarsal (no múscu-lo de Riolan, na extremidade medial e lateral da pálpebra superior) e pré-septal, reportando-se como vantagens a necessidade de quantidade menor da droga (24) , com poucos efeitos colaterais (25)(26)(27) , tais como a ptose palpebral. Apesar dos relatos sobre a necessidade de se aumentar em cerca de 50% a quantidade da droga a ser administrada com o passar do tempo (28) , os pacientes deste estudo continuam respondendo a mesma quantidade de medicamento usada no início do tratamento.…”

Section: Discussionunclassified

Blefarospasmo essencial e espasmo hemifacial: características dos pacientes, tratamento com toxina botulínica A e revisão da literatura

Schellini

Matai

Igami

et al. 2006

Arq. Bras. Oftalmol.

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INTRODUÇÃOO mecanismo fisiológico do blefarospasmo (espasmo do orbicular) e da síndrome de Meige (afeta também a face inferior e pescoço) ainda não é conhecido (1) . O blefarospasmo essencial e os espasmos faciais foram muitas vezes confundidos com doenças oculares ou distúrbios psíquicos (2) . Apesar do blefarospasmo não implicar em alterações oculares, algumas doenças dos olhos podem desencadeá-lo (3) e lesões oculares podem preceder o quadro, o que ocorre em cerca de 12,1% dos casos (4) . As alterações psíquicas, como comportamento obsessivo compulsivo (5) e esquizofrenia (6) podem estar presentes em portadores de blefarospasmo essencial.Apesar do blefarospasmo essencial estar presente em indivíduos sem qualquer alteração neurológica, disfunção de gânglios da base (5) ou lesão em núcleos da base, observadas por ressonância nuclear magnética (2) , já foram relatadas.O blefarospasmo pode ser desencadeado por medicamentos, como os neurolépticos (7) e pode haver predisposição genética em 9,5% (4) . É caracterizado por movimentos involuntários das pálpebras, por vezes com dificuldade de abertura palpebral (apraxia).Blefarospasmo essencial e espasmo hemifacial: características dos pacientes, tratamento com toxina botulínica A e revisão da literatura Descritores: Blefaroespasmo/quimioterapia; Espasmo hemifacial/quimioterapia; Toxina botulínica tipo A/uso terapêutico; Potenciais de ação; Músculos oculomotores RESUMO Objetivo: Conhecer as características dos portadores de blefarospasmo essencial e espasmo hemifacial, assim como a resposta ao tratamento utilizando toxina botulínica A. Métodos: Trinta e quatro portadores de blefarospasmo essencial ou espasmo hemifacial foram avaliados quanto a idade, sexo, queixas oculares, tempo de existência da doença, tipo de comprometimento, complicações e resultado do tratamento com toxina botulínica A. Resultados: A mediana da idade dos pacientes foi de 63 anos e a média, de 61 anos, sem diferença quanto ao sexo; 66,66% possuíam espasmo hemifacial e 33,33%, blefarospasmo essencial. Vários pacientes apresentavam também olho seco. A melhora com a utilização da toxina botulínica A ocorreu em 91,30% dos pacientes tratados. As complicações com o tratamento foram ptose palpebral (8,33%) e desvio da rima bucal (8,33%). Conclusão: O blefarospasmo essencial e o espasmo hemifacial geralmente acometem idosos, de ambos os sexos. O tratamento com a toxina botulínica A é eficiente, com índice muito baixo de complicações.

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“…It can occur as an isolated entity in progressive supranuclear palsy (PSP) and in other Parkinsonian states, and is suspected in patients with a BS that is refractory to a standard botulinum toxin A (BTX-A) technique in which the pretarsal and preseptal orbicularis oculi muscles are targeted [1]. Evidence to suggest differential effects from sites nearer the lid margin are suggested by several authors: Mackie [2] reported that patients with more severe symptoms of BS prefer the site of injection at either end of the upper eyelid near its margin. It has been reported that pretarsal muscle injections are more effective for treating BS than preseptal muscle injections [3].…”

Section: Introductionmentioning

confidence: 99%

Botulinum Toxin Injection into Riolan’s Muscle: Somatosensory ‘Trick’

Inoue

2007

Eur Neurol

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We studied the effect of injecting botulinum toxin A (BTX-A) into the pars ciliaris – also known as Riolan’s muscle – of patients with eyelid apraxia (ELA). Six patients with ELA were treated with injections of BTX-A into the region of Riolan’s muscle at the medial and lateral portions of the upper and lower pretarsal orbicularis oculi. Clinical benefit was seen in all 6 patients, 2 of whom had previously been treated with conventional pretarsal injections of BTX-A and had not improved. BTX-A injections into Riolan’s muscle are effective as treatment for ELA. The proposed mechanism is not that of muscle relaxation but rather modulation of the somatosensory cortex, similar to that of a ‘sensory trick’ in patients with dystonia.

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Riolan's muscle: Action and indications for botulinum toxin injection

Abstract: Riolan's injections of botulinum toxin are the preferred modality of treatment for all types of blepharospasm and cost considerably less.

Cited by 22 publications

References 6 publications

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

Blefarospasmo essencial e espasmo hemifacial: características dos pacientes, tratamento com toxina botulínica A e revisão da literatura

Botulinum Toxin Injection into Riolan’s Muscle: Somatosensory ‘Trick’

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