Use of Botulinum Neurotoxin in Ophthalmology

Abstract

Botulinum neurotoxin (BoNT) is the first biological toxin used in the treatment of ophthalmic diseases and to decrease skin wrinkles as an aesthetic agent. When used appropriately, it weakens the force of muscular contraction and/or inhibits glandular secretion. The most common areas for botulinum toxin treatment are the upper face, including the glabella, forehead, brows, and lateral canthal lines, or crow’s feet. By relaxing the muscles causing wrinkles, non-permanent results may be achieved with its use. BoNT has gained widespread use in a variety of ophthalmic diseases. The effect of BoNT is temporary, but the therapeutic benefit is usually maintained even after repeated injections. Treatment is usually well tolerated. Complications and side effects associated with the treatment are rare and temporary. Complications occur due to weakness (chemodenervation) of adjacent muscle groups, immunological mechanisms and injection technique. Current therapeutic indications, doses, complications and contraindications of BoNT use in the following disorders related to ophthalmology were investigated: aesthetic use, strabismus, blepharospasm, hemifacial spasm, eyelid retraction, entropion, lacrimal hypersecretion syndrome, and facial paralysis.

Effect of Cosmetic Procedures in the Periorbital Area on the Organ of Vision: Overview

“…Эта дозировка определяется безопасностью, а не эффективностью. Следует отметить, что введение ботулотоксина в больших объемах или при высоких дозах увеличивает площадь диффузии, тем самым повышая потенциальный риск возникновения побочных эффектов [32].…”

The Uses and Application Methods of Botulinum Toxin in Ophthalmology

“…17 Ortalama 2,5-10 MU transkonjonktival yolla üst tarsal sınırın hemen üzerinden levator-Müller kas yapısına yapılan enjeksiyon ile kapak aralığında geçici düzelme sağlanmaktadır. 23,24 Shih ve ark., 15 hastada 21 göz üzerine yapılan ça-lışmada, enjeksiyon öncesi ve sonrası birinci haftada ölçülen minimal kalıntı hastalığı değerlerinde ortalama -3,1 mm (0/-8 mm) azalma gözlemişler-dir.…”

“…17 Alt kapak kenarından yaklaşık 3-4 mm aşağıda subkütan olarak üç noktaya 5 MU enjekte edilmektedir. 26 …”

Botulinum Toxin- An Allrounder in the Ophthalmologist's Pharmacopoeia.

“…14 For strabismus, the average dose of Botulinum injection is 1-3 U/muscle 1 Complications include ptosis, acquired deviations and greater propensity of undercorrections, but this procedure is still very popular due to its less traumatic nature.…”

“…Generally, it can be used as an alternative to surgery in non restrictive strabismus like small to moderate angle infantile esotropia, acute esotropia, post surgical residual and consecutive esotropia, and 6 th nerve palsy. 7,8,9,1 Other indications include patients with strabismus who cannot tolerate general anesthesia and cases with unpredictable surgical results like partially accommodative esotropias, esotropias in cerebral palsy and Thyroid eye disease. It has also been used in management of vertical deviations and nystagmus.…”