Noncosmetic periocular therapeutic applications of botulinum toxin

Abstract

Botulinum toxin blocks acetylcholine release at the neuromuscular junction. The drug which was initially found to be useful in the treatment of strabismus has been extremely effective in the treatment of variety of conditions, both cosmetic and noncosmetic. Some of the noncosmetic uses of botulinum toxin applications include treatment of spastic facial dystonias, temporary treatment of idiopathic or thyroid dysfunction-induced upper eyelid retraction, suppression of undesired hyperlacrimation, induction of temporary ptosis by chemodenervation in facial paralysis, and correction of lower eyelid spastic entropion. Additional periocular uses include control of synchronic eyelid and extraocular muscle movements after aberrant regeneration of cranial nerve palsies. Cosmetic effects of botulinum toxin were discovered accidentally during treatments of facial dystonias. Some of the emerging nonperiocular application for the drug includes treatment of hyperhidrosis, migraine, tension-type headaches, and paralytic spasticity. Some of the undesired side effects of periocular applications of botulinum toxin inlcude ecchymosis, rash, hematoma, headache, flu-like symptoms, nausea, dizziness, loss of facial expression, lower eyelid laxity, dermatochalasis, ectropion, epiphora, eyebrow and eyelid ptosis, lagophthalmos, keratitis sicca, and diplopia.

Senile lower lid entropion successfully treated with botulinum toxin A

“…BT (an exotoxin produced by Clostridium botulinum) blocks the release of acetylcholine at the neuromuscular junction. It is useful in many diseases such as strabismus, spastic facial dystonias, idiopathic or thyroid dysfunction‐induced upper eyelid retraction, hyperlacrimation, facial paralysis, control of synchronic, and correction of lower eyelid spastic entropion …”

“…Muscle weakness becomes evident in about 7 days due to the continuous release of acetylcholine from vesicles that have not been blocked by the toxin. Recovery of muscle activity typically begins 4 months after injection, and it is thought to occur due to the regeneration of new endplate units …”

“…Undesired side effects of BT are rash, ecchymosis, hematoma, headache, flu‐like symptoms, ectropion, epiphora, eyebrow and eyelid ptosis, lagophthalmos, keratitis sicca, and diplopia …”

Therapeutic Uses of Botulinum Toxin

“…There is some evidence that botulinum toxin can be useful in dry eye disease [88][89][90], although paradoxically, keratitis sicca (dry eye syndrome) can result as a side-effect of botulinum toxin injections in periocular procedures [91]. Recently, in a randomised non-controlled trial involving 60 patients with dry eyes, 36 were treated with punctal plug insertion and 24 were given botulinum toxin injections [90].…”

Paralysis of the orbicularis muscle of the eye using botulinum toxin type A in the treatment for dry eye

“…The use of botulinum toxin was introduced in ophthalmology for the first time in 1980 for the treatment of strabismus, and since then, it has been extended for various uses both cosmetic and non‐cosmetic (Scott ; Kaltreider et al. ; Kaynak‐Hekimhan ). The botulinum toxin is a neurotoxin produced by Clostridium botulinum , which acts on the motor end plate of neurons, and when injected locally causes muscle paralysis interfering with the release of acetylcholine at neuromuscular junctions (Horwath‐Winter et al.…”