Botulinum
Toxin Chemodenervation Therapy
Botulinum toxin, a neurotoxin that is widely used in neuromuscular disorders, has wide applications in Ophthalmology. Stimulated by its continued need, patient demand, and co-operation from
Allergan, the Botulinum Toxin Clinic is now operational at the LV Prasad Eye Institute.
Following is a brief review of its current indications, methodology, and logistics at the Clinic.
What is Botulinum Toxin?
Botulinum toxin is a natural, purified protein neurotoxin from the anaerobic bacterium Clostridium
Botulinum. When injected directly into the muscle, it produces chemical denervation of the motor end plate.
What are the
current indications for Botulinum Toxin in ophthalmology?
- Essential blepharospasm
- Hemifacial spasm
- Eyelid myokimia (eyelid twitching)
- Facial nerve palsy and misdirection
- Senile lower lid entropion
- Primary lacrimal gland hypersecretion
- Chemo-tarsorraphy in corneal exposure
- Acquired nystagmus with oscillopsia
- Strabismus: paralytic and non-paralytic
Botulinum toxin is not recommended during pregnancy, lactation, and in patients with neuromuscular disease.
What are the Cosmetic Indications for Botulinum Toxin?
Botulinum toxin is currently the leading cosmetic procedure in the West, and is US FDA approved for cosmetic use.
Applications include:
- Periocular cosmesis
- Frown lines between the eyebrows
- Horizontal forehead wrinkles
- Crow's feet or smile lines around the eyes
- Facial rejuvenation
- Naso-labial folds
- Peri-oral rhytids
- Chin dimpling or creasing
How is Botulinum Chemodenervation Performed?
- Video-assisted clinical assessment of the patient is done to identify the overacting facial muscles or the stress lines as indicated.
- The toxin dose and injection sites are then determined by the activity and amount of muscle mass.
- A single patient may need from 10-35 units of toxin
- The toxin, available as a 100-unit vial is reconstituted with normal saline, and injected within 4 hours.
What can be expected from the Treatment?
- This relatively new procedure offers a simple and effective outpatient treatment requiring not more than 10 minutes.
- The maximal paralytic action appears in a week, and lasts for up to 4 months, depending on the individual.
- To maintain the effect, the patient requires 2-3 injections per year. Studies show that with multiple treatments the effect lasts longer, thereby requiring less frequent treatment.
Is
Botulinum Toxin Expensive?
- In facial dyskinesias, the other available options like continued medications or neurosurgical decompression have limited success and a high morbidity and mortality.
- In comparison, Botulinum toxin chemodenervation is quite affordable, simple, safe, and more effective treatment providing a better quality of life.
- For cosmetic indications, it is relatively less expensive and more effective than other appearance related investments like facials and wrinkle creams, and injectable fillers.
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