Título

BOTULINUM TOXIN TYPE A IN THE MANAGEMENT OF EYELID PTOSIS

Objetivo

Mild ptosis, especially unilateral cases, can be aesthetically displeasing for patients. However, some patients do not desire to undergo a surgical ptosis repair. Botulinum toxin injection might be an option to reduce asymmetries caused by eyelid ptosis. This study aims to examine the effects of botulinum neurotoxin A (BoNT-A) injection into the pre-tarsal orbicularis oculi muscle in the management of mild to moderate blepharoptosis.

Método

In this prospective study, eight patients with mild to moderate ptosis received application of BoNT-A (Botox®, Allergan, Irvine, CA) in the pre-tarsal portion of the orbicularis oculi muscle. The patients were assessed at baseline, four and 24 weeks after BoNT-A injection. Primary outcomes were the variation of the margin reflex distance -1 (MRD-1) and qualitative changes in a 4-level scale. A digital image analysis software (Image J) was used for objective analysis. Adverse effects were also recorded.

Resultado

Eight patients (6 female, 2 male) were enrolled in this study (mean age 52.38±15.26 years). A significant increase of 0.5mm (p=0.0007) was observed in the MRD-1 on the treated side and a reduction, although not significant (0.07mm, p>0.99), was observed in the MRD-1 on the contralateral eyelid at week 4. After 24 weeks, the effect of BoNT-A diminished, with the mean MRD-1 of the treated side reducing its increase to 0.39mm (p=0.06); the fellow eyelid sustained its position with a mild reduction of 0.06mm (p>0.99). No serious adverse events were identified. Subjectively, 87.5% of the patients reported some degree of improvement in their eyelid ptosis.

Conclusão

Botulinum toxin injection in the pre-tarsal orbicularis oculi muscle can be an option to temporarily manage ptosis in patients who do not desire to undergo a surgical procedure. Eyelid asymmetry was shown to be significantly improved at 4 weeks. This alternative treatment can also be used to manage temporary ptosis induced by botulinum toxin diffusion to the levator aponeurosis.