BOTULINUM TOXIN A-INDUCED PROTECTIVE PTOSIS IN INDOLENT CORNEAL ULCERS OR EROSIONS

Background Botulinumtoxin A has been introduced as a local injection t herapy of different conditions with focal muscular hypercontractions. Ln the ophthalmologic field the toxin has proven its efficacy in the t herapy of blepharospasm and hemifacial spasm. There are only few repor ts on the use of a botulinum toxin A to induce a protective ptosis in patients with persistent corneal ulcers.Patients and methods 21 patien ts who failed to respond to conservative therapy of corneal erosions o r ulcers of different origin received a botulinum toxin A injection in to the levator palpebrae superioris muscle. Results The ptosis began a fter a mean of 1.5 days (1-3 days) and was complete after a mean of 5. 1 days (3-12 days) after injection. Complete recovery of the levator f unction could be observed after a mean of 12.4 weeks (4-24 weeks). In 13 patients (61,8%) the botulinum toxin A induced protective ptosis le ad to a complete healing of indolent ulcers or erosions, in 4 patients (19%) an additional tarsorrhaphy was necessary. In 3 patients no heal ing could be observed during follow up, in one patient (with neuropara lytic ulcer) the injection was given prophylactically. The period of h ealing on average was 3,8 weeks. There was no relationship between the healing rate and the duration of the corneal disease prior to the bot ulinum toxin injection. The mean healing rate of younger patients was higher (75%) than that of older patients (53.8%) and higher in erosion s (70%) than in ulcers (30%). No side effects were observed besides in one patient the undesirable duration of the ptosis of a half year. Co nclusion The induction of a protective ptosis with botulinum toxin A i njection is an efficacious treatment alternative in persistent corneal erosions and ulcers before performing a tarsorrhaphy. This method is preferrable especially in patients with lagophthalmos due to facial ne rve paresis with potential recovery.