Botulinum toxin considered for multitude of eye problems

Chicago-Botulinum toxin type A (Botox, Allergan), originally approved by the FDA as an orphan drug for the treatment of strabismus and blepharospasm, has been found to be effective for the treatment of hemifacial spasm, Meige syndrome, nystagmus, and lid retraction in Graves’ disease, according to Matthew Dean Kay, MD, adjunct clinical associate professor, Nova Southeastern University, Pompano Beach, FL.

Hemifacial spasm, a common craniofacial movement disorder, is characterized by unilateral muscle contractions of the face. It can involve a combination of orbicularis oculi, frontalis, risorius, zygomaticus major, and platysmas muscles. The hemifacial spasm injection pattern usually requires four to five injections (2.5 to 5 units per site) around the affected eye and within the affected facial area. The treatment typically lasts for 3 to 4 months, explained Dr. Kay during a session on therapeutic neuro-ophthalmology at the subspecialty day meeting on Saturday.

Botulinum toxin injections have been used in patients with Meige syndrome, a condition involving blepharospasm accompanied by lower facial twitches and contortions, he said. However, high doses are required.

It is also useful for controlling nystagmus and is administered in a standard retrobulbar technique of 2.5 units, Dr. Kay said.

Off-label uses include lid retraction associated with Graves’ disease, epiphora, and headache management.

Surgeons should warn patients about possible side effects of botulinum toxin, such as bruising, ptosis, diplopia, excessive facial weakness, ectropion, superficial punctate keratitis, tearing, dryness, and lagophthalmos, he noted.