Botulinum Toxin-A Protective Ptosis in the Treatment of Lagophthalmos Associated with Facial Paralysis

Abstract

Purpose: 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. Conclusion: 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. © 2012 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.