Reversible pupillary dilation following botulinum toxin injection to the lateral rectus

Hemmerdinger, Christopher M; Srinivasan, Sathish; Marsh, Ian

doi:10.1038/sj.eye.6702366

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…Botulinum toxins (BTx) block the release of ACh at neuromuscular junctions, post-ganglionic parasympathetic nerve endings, and post-ganglionic sympathetic nerve endings that release Ach, resulting in paralysis of the sympathetic and parasympathetic innervation of the iris [ 125 , 126 ]. This may result in transient pupil dilation and attenuation of the PLR by uptake of BTx into the parasympathetic ciliary ganglion or the parasympathetic neuromuscular junctions at the iris sphincter muscle [ 127 ]. There are a number of reports in the literature describing mydriasis with an attenuated PLR as a consequence of ingesting contaminated food [ 128 ], or following injection of BTx [ 129 , 130 ].…”

Section: Clinical Applications Of Pupillometrymentioning

confidence: 99%

Eyeing up the Future of the Pupillary Light Reflex in Neurodiagnostics

2018

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The pupillary light reflex (PLR) describes the constriction and subsequent dilation of the pupil in response to light as a result of the antagonistic actions of the iris sphincter and dilator muscles. Since these muscles are innervated by the parasympathetic and sympathetic nervous systems, respectively, different parameters of the PLR can be used as indicators for either sympathetic or parasympathetic modulation. Thus, the PLR provides an important metric of autonomic nervous system function that has been exploited for a wide range of clinical applications. Measurement of the PLR using dynamic pupillometry is now an established quantitative, non-invasive tool in assessment of traumatic head injuries. This review examines the more recent application of dynamic pupillometry as a diagnostic tool for a wide range of clinical conditions, varying from neurodegenerative disease to exposure to toxic chemicals, as well as its potential in the non-invasive diagnosis of infectious disease.

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Section: Clinical Applications Of Pupillometrymentioning

confidence: 99%

Eyeing up the Future of the Pupillary Light Reflex in Neurodiagnostics

2018

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“…Botulinum toxins could therefore cause pupil dilatation by uptake into the parasympathetic neurons at the level of the ciliary ganglion or the parasympathetic neuromuscular junctions in the sphincter pupillae of the iris. 5 It has been shown in animal studies that botulinum toxin injected intracamerally or near the ciliary ganglion causes mydriasis. 3 Persistent mydriasis has been reported after medial rectus muscle injection of botulinum toxin for esotropia in a child.…”

Section: Discussionmentioning

confidence: 99%

Unilateral transient mydriasis and ptosis after botulinum toxin injection for a cosmetic procedure

Akkaya

Kökçen

Atakan

2015

OPTH

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We report a case of unilateral transient mydriasis and ptosis after botulinum toxin injection applied by a medical doctor for a cosmetic procedure. A 36-year-old nurse was referred to our eye clinic with unilateral mydriasis and ptosis in the right eye 3 days after botulinum toxin injection for a cosmetic procedure. Botulinum toxin was applied to her eye by a doctor at her hospital who was not an ophthalmologist. She was treated with topical apraclonidine 0.5% ophthalmic solution. Her ptosis decreased to 2 mm with apraclonidine and her visual axis improved. Mydriasis was present for 3 weeks and then disappeared. Mild ptosis continued for 3 months, then resolved completely. Patients seeking treatment with botulinum toxin A for cosmetic purposes should be warned about the possibility of ptosis and mydriasis after injection. If these side effects are seen, the patient must be referred to an ophthalmologist for appropriate management.

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“…Botulinum toxin A (BTX-A) injection is used for treatment of strabismus, blepharospasm and for cosmetic purposes. There are some reports of transient mydriasis or tonic pupil as a complication of these procedures [1,6,14]. The cause of transient mydriasis is either from pharmacological blockage of cholinergic activity by means of trans-scleral diffusion or ciliary artery perfusion, if the injection is superficial to the muscle or from direct injury occurs at the level of CG in the event that injection is too deep [1,6,14].…”

Section: Introductionmentioning

confidence: 99%

Morphometric study of the ciliary ganglion and its pertinent intraorbital procedure

2020

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Background: Ciliary ganglion (CG) can be easily injured without notice in many intraorbital procedures. Surgical procedures approaching the lateral side of the orbit are at risk of CG injury which results in transient mydriasis and tonic pupil. This study aims to focus on the morphometric study of the CG which is pertinent to intraoperative procedure. Materials and methods:Forty embalmed cadaveric globes were dissected to observe the location, shape and size of CG, characteristics and number of roots reaching CG, number of short ciliary nerve in the orbit. Distances from CG to posterior end of globe, optic nerve, lateral rectus muscle and its scleral insertion were measured.Results: CG was located between optic nerve and lateral rectus in every case. Its shape could be oval, round and irregular. Mean width of CG was 2.24 mm and mean length was 3.50 mm.Concerning the roots, all three roots were present in 29 cases (72.5 %). Absence of motor root was found in 7 cases (17.5 %). Absence of sympathetic root was found in 4 cases (5%).The number of motor root could be one, two and also three roots. Three motor roots were found in one case which originated from nerve to inferior oblique muscle. Only one sensory root was found in every specimen. One sympathetic root could be observed in most of the 2 specimens and 6-14 short ciliary nerves were found. Mean distances from CG to posterior end of globe, optic nerve, lateral rectus muscle and its scleral insertion were 16.04 mm, 1.47 mm, 2.88 mm. and 31.53 mm, respectively. Conclusions:This study described the characteristic of CG, number of its nerve root and some measurements relevant to intraorbital procedures in Asian population. Moreover, a new parameter was the distance between CG and scleral insertion of the lateral rectus muscle. This parameter should be considered when performing operation involved the lateral rectus muscle and BTX-A injection to lateral rectus muscle to reduce CG injury.

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Reversible pupillary dilation following botulinum toxin injection to the lateral rectus

Cited by 11 publications

References 11 publications

Eyeing up the Future of the Pupillary Light Reflex in Neurodiagnostics

Eyeing up the Future of the Pupillary Light Reflex in Neurodiagnostics

Unilateral transient mydriasis and ptosis after botulinum toxin injection for a cosmetic procedure

Morphometric study of the ciliary ganglion and its pertinent intraorbital procedure

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