Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm

Abstract

Although the beneficial effect of subcutaneous injections of botulinum toxin type A (BTX-A) is well known in both blepharospasm and hemifacial spasm, the position of the injection sites around the orbicularis oculi may influence the effectiveness and side effects. Here we report results of preseptal and pretarsal BTX-A injections in 53 patients (25 blepharospasm and 28 hemifacial spasm) in whom we used both injection techniques successively. Pretarsal injections were used in 102 out of 186 treatments in blepharospasm group and in 84 out of 202 treatments in hemifacial spasm group. Pretarsal BTX-A treatment produced significantly higher response rate and longer duration of maximum response in both patient groups. This technique was also associated with a lower frequency of major side effects such asptosis. We concluded that injections of BTX-A into the pretarsal, rather than the preseptal portion of the orbicularis oculiis more effective for treatment of involuntary eyelid closure due to contractions of this muscle.

Botulinum Toxin Application Experiences in Adıyaman University, Department of Neurology: A Retrospective Study

“…Yan etkiler uygulama yerine göre değişir ve ilacın uygulandığı kastan komşu kaslara toksinin difüzyonuna bağlıdır 11,12 . Ayrıca orbicularis oculi kasının pretarsal bölümüne yapılan uygulamaların daha başarılı sonuç-lar verdiği ve en önemli yan etki olan ptozis sıklığında azalmaya neden olduğu gösterilmiştir [13][14][15] . Yapılan ça-lışmada orbicularis oculi kasının pretarsal bölümüne yönelik BoNT-A uygulamalarında sadece 1 hastada hem pitoz hem de diplopi gelişmişti.…”

“…Yapılan ça-lışmada orbicularis oculi kasının pretarsal bölümüne yönelik BoNT-A uygulamalarında sadece 1 hastada hem pitoz hem de diplopi gelişmişti. Genel hasta sayımıza bakıldığında klinik yarar sağladığını ortaya konmuştu 13 . Ptoz toksinin levator palpebra kasına difüzyonu sonucu en sık görülen yan etki olduğundan bunu önlemek için toksin yüksek konsantrasyonlu hazırlandı ve üst göz kapağı uygulamalarında orta hat enjeksiyonundan kaçınıldı.…”

Applications of Botulinum Toxin at a Neurology Clinic: An Eleven-year Experience

“…Lower rate of oral asymmetry in this study may be due to avoiding injections to the lower face and using lower doses if not necessary. Cakmur et al (25) compared pretarsal injections with preseptal injections in 25 patients with BPS and 28 patients with HFS. The authors detected elevated response rates and longer effect duration in patients who received pretarsal injections.…”

Hemifacial Spasm: A Neurosurgical Perspective

“…Blepharospasm is a bilateral condition characterized by focal, excessive involuntary closure of the eyelids generally caused by spasm of the orbicularis oculi muscles 2,21,22) and it may sometimes lead to functional blindness 8) . Despite having different pathophysiology, both HFS and blepharospasm produce involuntary eyelid closure due to contractions of the orbicularis oculi muscle.…”

“…Most common injection sites are pretarsal and preseptal portions. Cakmur et al showed that pretarsal injections of BTX-A in patients with involuntary eyelid closure due to contractions of the orbicularis oculi muscle are associated with higher efficacy and lower frequency of complications than preseptal injections 8) . Although BTX-A injection shows high success rate of treatment of HFS and blepharospasm, its substantial limitation is that it required repeat injection, which eventually lead to charge of high economic cost because of uncoverage under current national health insurance policy.…”