The good toxin: 10 years of experience with botulinum toxin A in the treatment of benign essential blepharospasm.

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To describe the efficacy and safety of botulinum toxin A (Botox) in patients with benign essential blepharospasm. Retrospective review of operation, injection, and medical records. Information of 29 patients (nine males) was reviewed, and the average age of benign essential blepharospasm onset was 59.1 years. The average number of injections per patient was 14.2 ± 8.2 (5-44) and the average follow-up was 75.8 ± 47.3 months (15-180). The average unit dose was 14.2 ± 8.2 (10-30) ipsilaterally in the patient's first year and was 21.4 ± 5.0 (12.5-30) ipsilaterally in their last year (p = 0.00458). The average onset time was 3.8 ± 1.9 (1-7) days in a patient's first year and was 3.6 ± 1.7 (2-7) days in their last year (p = 0.549). The average effective duration was 2.86 ± 1.1 months in a patient's first year and was 2.53 ± 0.9 in their final year (p = 0.187). The Subjective Spasm Alleviation Scale was 1.72 ± 0.4 at the first year and was 1.79 ± 0.5 in the last year (p = 0.187). Ten (34.5%) patients with eyelid disease had surgical correction. The Subjective Spasm Alleviation Scale was 1.50 ± 0.5 before and was 2.0 ± 0 six months after the operation (p = 0.0268). Post-injection complications were experienced in eight (27.6%) patients. The most common complication was ptosis (n = 7), followed by diplopia (n = 1), dry eye (n = 1), and tearing (n = 1). No life-threatening complication was reported. Botox was a safe and effective treatment in benign essential blepharospasm which required an increased dosage over time. Ptosis was the most common complication and no life-threatening condition was reported. Surgical correction of those with eyelid diseases showed subjective improvement of subsequent Botox treatment.