Abstract
Purpose: :
Facial movement disorders frequently require treatment to address associated ocular problems. Botulinum toxin type A (BTX-A) injection therapy has largely replaced surgery as the primary treatment for facial dystonias. The purpose of this study was to evaluate the clinical applications and associated outcomes of BTX-A injection therapy for facial dystonias with emphasis on post-injection complications.
Methods: :
A retrospective chart review. Patients were identified from the Department of Ophthalmology and Visual Sciences at the University of Iowa Hospitals and Clinics between 1984 and 2009 that received periocular BTX-A injections for facial movement disorders. Data obtained: gender, diagnosis, age at first treatment, number of visits, units of BTX-A injected per visit, surgical interventions before or during treatment, and complications.
Results: :
A total of 334 patients were included in the study. Gender: 38.6% male and 61.4% female. Diagnoses: 47.6% benign essential blepharospasm, 42.2% hemifacial spasm, 6.6% aberrant regeneration without hemifacial spasm, 2.1% various conditions, and 1.5% myokymia. Mean age at first treatment: 62.5 years. Mean number of visits: 11.5. Mean number of units of BTX-A injected per visit: 40. Surgical interventions: 23.1%. Complications: 12.3% signs of corneal irritation, 8.4% lack of desired effect, 3.8% ptosis, 3.7% complaints of dry/irritated eye, 1.9% tearing, 1.8% undesired effect on untargeted muscles, and 0.91% diplopia.
Conclusions: :
Benign essential blepharospasm and hemifacial spasm accounted for more than 89% of the facial dystonias treated with BTX-A injection therapy. The most common adverse effects associated with BTX-A therapy were signs of corneal irritation, lack of desired effect, ptosis, and dry/irritated eye symptoms. Only one in three patients with corneal irritation complained of dry/irritated eyes. The corneas of patients receiving BTX-A therapy for facial movement disorders should be screened at follow up regardless of symptoms.
Keywords: eyelid • cornea: tears/tear film/dry eye • clinical (human) or epidemiologic studies: outcomes/complications