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Lily Huang, Bryan Costin, Natta Sakolsatayadorn, Julian Perry; Safety of Botulinum Neurotoxin Injection to the Central Upper Eyelid and Eyebrow Regions. Invest. Ophthalmol. Vis. Sci. 2013;54(15):741.
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To evaluate the safety of botulinum neurotoxin injected into the central upper eyelid and eyebrow.
We retrospectively reviewed the charts of all patients undergoing botulinum neurotoxin injection to the central upper eyelid and eyebrow at Cole Eye Institute between February 2012 and November 2012. Central eyelid was defined as horizontally between the medial and lateral canthus and vertically from the eyelid margin to the brow skin. Central eyebrow was defined as horizontally between the medial and lateral canthus and vertically from the eyebrow skin several millimeters inferior to the eyebrow cilia to the superior most eyebrow cilia. Age, gender, indication, neurotoxin type, injection sites, number of central units, total number of units, success rates, and occurrence of adverse events were all recorded.
A total of 313 procedures on 92 patients were performed in which the central upper eyelid and/or central eyebrow was injected with botulinum neurotoxin. There were 72 female and 20 male patients. Average age was 66 years (42 - 92 years). Indication for central eyelid/eyebrow treatment included blepharospasm (36 patients, 184 procedures), hemifacial spasm (21 patients, 40 procedures), facial nerve disorders (4 patients, 14 procedures), and facial rhytides/eyebrow ptosis (31 patients, 75 procedures). The quantity of neurotoxin injected into the central eyelid and eyebrow ranged from 2.5 to 17.5 units. Complications included diplopia (4.5% of total encounters), lagophthalmos (2.2% of total encounters), blepharoptosis (1.0% of total encounters), and blurry vision (1.0 % of total encounters). Local effects, including bruising, bleeding, pain, and mild swelling were recorded in 3.8% of total encounters.
Placement of botulinum neurtoxin into the central upper eyelid and eyebrow is associated with a low rate of blepharoptosis, similar to blepharoptosis rates found in studies investigating complications from traditional peri-ocular botulinum neurtoxin injections. Patients who experienced complications with one procedure are more likely to experience complications with subsequent injections. Central eyelid and eyebrow neurotoxin injection for treatment of essential blepharospasm, hemifacial spasm, facial nerve disorders and eyebrow ptosis is associated with a low complication rate and can be added to the treatment regimen when central orbicularis chemodenervation is indicated.
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