Botulinum toxin A-induced ptosis: A safe and effective alternative to surgical tarsorrhaphy for corneal protection

Abstract

AimThe aim of the study was to evaluate the corneal protective effect of botulinum toxin A-induced ptosis in the treatment of various corneal pathological conditions in which surgical tarsorrhaphy was indicated.Patients and methodsThis prospective study included 25 eyes (25 patients) with various ocular conditions in which surgical tarsorrhaphy was indicated, and it was replaced by botulinum toxin A injection. Corneal pathology included 16 patients with resistant fungal ulcers, four with persistent corneal epithelial defect, one with central corneal melt due to rheumatoid arthritis, and four with Bell's palsy. Patients were injected with a dose of 5 U of Botox A using a 26-G insulin syringe. Patients were followed up daily during the first week, and if they did not achieve complete closure of the lid aperture repeat injection of 5 U was given.ResultsAll patients had complete ptosis; however, six (24%) required repeat injection after 1 week. Superior rectus underaction was not recorded in any patient. Corneal pathology was improved in all, but one patient had corneal melt secondary to rheumatoid arthritis and required a tectonic corneal graft. The main duration for complete ptosis to develop was 6.8 ± 1.96 days (range 5-12 days). The duration for induced ptosis to recover was 55.64 ± 10.24 days (range 44-66 days).ConclusionBotulinum toxin A-induced ptosis is a good alternative to surgical tarsorrhaphy as a means of corneal protection in various forms of corneal pathology.