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D. Khalatbari, K.M. Hammersmith, R. Penne, P.K. Nagra, E.J. Cohen, C.J. Rapuano, P.R. Laibson; Botulinum Toxin Induced Ptosis in Persistent Corneal Epithelial Disease . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5007.
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Tarsorraphy can promote reepithelialization in non–healing corneal epithelial disease. Traditional suture tarsorraphy, however, is invasive, limits subsequent examinations, complicates the administration of topical medicines, and may lead to permanent anatomical abnormalities. Alternatives to suture tarsorraphy continue to be explored. In this study, we investigated the use of botulinum toxin A (Botox) induced ptosis to promote the healing of persistent corneal epithelial defects.
Botox was injected into the levator superioris palpebrae muscle of 11 patients with non–healing corneal epithelial defects. For safety reasons, eyes with previously poor vision (20/400 or worse) were selected for this study. Patients were followed post–injection. Data collected included patient age and sex, indication for injection, duration of signs and symptoms before injection, degree of and time to ptosis, time to epithelial healing, and complications.
Four men and seven women with an average age of 73 years (range, 30 to 94) participated in this study. Indications for injection were persistent corneal epithelial defects following bacterial keratitis (6), in neurotrophic eyes with previous herpes zoster (4), and following severe alkali burn (1). Participants had a mean duration of 22.9 days (range, 7 to 40) of signs and symptoms before injection. Complete ptosis was noted in six of eleven eyes (54.5%) at the first post–injection examination (median 3 days; range, 1 to 11) with reepithelialization occuring in five of the six. No patients developed limitation in extraocular movements following injection. One patient with complete ptosis required evisceration after corneal perforation one day post–injection. Of the five patients without complete ptosis, one achieved ptosis sufficient to allow healing by the first post–injection exam, three required suture tarsorraphy, and one required subsequent amniotic membrane transplantation.
Botox induced ptosis can be a practical alternative to suture tarsorraphy in the treatment of eyes with non–healing corneal epithelial defects and poor visual prognosis. Patients should be advised that additional therapy may be required if the Botox injection is unsuccessful.
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