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K Boboridis, NG Ziakas, C Bunce, N Georgiadis, NT Stangos; Management Of Lagophthalmos In Facial Nerve Palsy With Botulinum Toxin . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3032.
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Purpose:Upper lid retraction from the unopposed levator action following Facial nerve palsy can result in severe lagophthalmos and exposure keratopathy. The available treatment modalities include lid taping, lateral tarsorrhaphy, levator complex recession and gold weight insertion. We present our experience with the use of Botulinum Toxin for weakening of the levator muscle in the management of upper lid retraction. Methods:Seven consecutive patients with short history of seventh nerve palsy and upper lid retraction were included. Vertical palpebral aperture, upper and lower lid position, sclera show, lid closure, Bell’s phenomenon and lagophthalmos were evaluated. In all cases there was inadequate lid closure with 4-7 mm lagophthalmos, paralytic lower lid ectropion with sclera show, good Bell’s phenomenon and symptomatic punctate exposure keratopathy. Botulinum Toxin (10-20 IU) was administered with a 26 G needle deep into the upper lid sulcus, above Whitnall’s ligament at the top of levator muscle. Patients were evaluated every week post treatment for a period of at least six months. Results:Lid position improved significantly in all cases within ten days from treatment. Upper lid retraction was corrected with much weaker levator function and lid position above the pupil keeping the visual axis clear. Better lid closure and less lagophthalmos helped cornea protection and cured exposure keratopathy symptoms. No ocular motility defects were noted. Facial nerve function improved spontaneously in four cases, the remaining three required repeat injection in three months time. Conclusion:Chemical denervation of levator muscle with Botulinum Toxin is a simple and effective treatment of upper lid retraction following facial nerve palsy. It offers an alternative treatment to surgery, specially in temporary nerve palsy, with optimum patient satisfaction.
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