BOTOX! BETTER OPTION TO PROTECT CORNEA IN IDIOPATHIC BELL’S PALSY

Abstract

Aim: Is to evaluate the efficacy of Chemo-denervation of LPS to induce temporary ptosis using Injection Botox in protecting Cornea and healing exposure keratopathy. Materials & Methods: Prospective interventional study conducted at Tertiary eye care centre of Hyderabad. Study period between June 2010 to May 2012. 24 cases of Bell’s palsy , 11 males & 14 females between age group of 20-80 years were included in the study. Facial palsy due to CP angle tumors, Hansen’s disease, Trauma, CSOM and post mastoidectomy were excluded as these are permanent causes. Patient with known allergy to Botox and patient who lost to follow up were also excluded. Cases included were examined by an ophthalmologist and radiologically evaluated to rule out other causes of facial palsy. Height of palpebral aperture, amount of Lagophthalmos, exposure keratopathy was documented. 0.25cc of injection Botox containing 6.25IU of Botox was injected at the insertion of LPS. Patient was examined at the end of 1st week, 2nd week, 4th week and 8th week to check all the 3 parameters. Results: At the end of 1st week in 16 cases mean palpebral height of 9mm (SD +/- 1.2mm) before injection was reduced to 2mm (SD+/- 1.0mm) after injection. At the end of 2nd week 8 cases achieved ptosis. Mean difference in Palpebral aperture height was 7mm (p value of 0.05) which is significant. All cases showed improvement in exposure keratopathy. 20 cases recovered from Bell’s palsy within 8 weeks . 4 cases required 2nd injection of Botox as ptosis started recovering but Bell’s palsy persists. Mean amount of Lagophthalmos of 4.3mm (SD+/- 0.7mm) before injection was reduced to 1.1mm (SD+/- 1.0mm) at the end of 2nd week. P value of <0.05 which is significant. Conclusion: Inj.Botox is safe and effective method to achieve ptosis by Chemo-denervation of LPS. Action of Botox remains for 8 weeks wherein 85% of cases recovered from Bell’s palsy.