Is to analyse the effectiveness of botulinum toxin injection in treating periocular spasms.

A 10 year retrospective case notes review of 168 patients who received botulinum toxin injection for periocular spasm. They were evaluated based on indications,ocular complaints,treatment outcomes and complications.

One hundred and sixty eight patients received botulinium toxin injection for periocular spasm of which 84(50 %)had essential blepharospasm,38 (27%) had hemifacial spasm,41 (24%)had facial palsy with aberrant reinnervation including iatrogenic causes,4 (2%) apraxia of the eyelid opening and 1(0.5%)other causes.The age group ranged from 28 to 90 years with the mean age of 62 years.57% (95) of females and 43% (73)of males received toxin.All patients underwent thorough ophthalmic examination to exclude ocular surface diseases.Patients with hemifacial spasm were investigated with MRI brain to rule out vascular loop and cerebropontine angle lesions prior to injection. Dose varied between 2.5U to 5U.The majority of patients received injection to 2 lids 57% (96) followed by 4 lids 33% (56) and 7% (12) lacrimal gland;however 2.3%(4) declined treatment.Muscle spasm reduced significantly within 2 days of the first injection and effect lasted for 10 to 12 weeks.96% of patients had regular injections every 3 months.Complications related to the treatment included transient ptosis 1%(2), diplopia 0.5% (1)and watering 0.5% (1).One patient needed surgical correction for toxin induced ptosis. 6%(10)patients who were unresponsive to botulinum toxin underwent orbicularis stripping(8) and frontalis brow suspension(2).

Treatment with botulinum toxin was effective in periocular spasm, with very low complication rates.