The Application of Dysport® – the Possibilities of the Side Effect on the Eyelids Position (a Clinical – Histological study)

Authors: J. Krásný;  J. Šach
Authors‘ workplace: Oční klinika FNKV, Praha, přednosta prof. MUDr. Pavel Kuchynka, CSc. ;  Ústav patologie 3. LF UK a FNKV, Praha, přednosta prof. MUDr. Václav Mandys, CSc.
Published in: Čes. a slov. Oftal., 68, 2012, No. 5, p. 216-220
Category: Original Article

Předneseno na XVI. Výročním sjezdu ČOS ve Špindlerově Mlýně, září 2008


To inform about the possibility of negative influence of repeated application of the botulotoxine A derivate on the eye lid position with the changes of their tissue structure. At the same moment, the authors report on literature analysis of positive and negative influence of this neuro toxine from the medical point of view.

Materials and methods:
At the Department of Ophthalmology in the Faculty Hospital Královské Vinohrady, Prague, Czech Republic, E.U., there were surgically treated three patients after repeated applications of botulotoxine A derivates. The first case was bilateral ptosis of upper eyelids; the other two were indicated because of entropium with trichiasis of lower eyelids. In the medical history, there was recorded ten years lasting above-mentioned drug treatment for blepharospasm diagnosis in a 65 years old man introducing bilateral symmetrical ptosis. Because of the following frontal muscle involvement, and partial decreasing levator palpebrae muscles function, the positioning of the upper eyelids was treated by the aponeurosis plasty with good functional result. In two female patients, aged 72 and 90 years, the indication for successful surgical treatment was chronic entropium of lower eyelids; initially ineffectively treated by means of repeated intradermal injections of botulotoxin A derivates.

Histological examinations of the excided skin and subcutis samples taken during ectropium plasties showed unfavorable and irreversible changes including especially scarring of the eyelid and atrophy of the striated muscles.

The indication of botulotoxine A derivates application should be carefully weighted and the proper indication should be chosen. From the ophthalmologic point of view, blefarospasmus only is the appropriate diagnosis, and the relative indication is the temporary induced ptosis of the upper eyelid closing the interpalpebral fissure to prevent corneal changes in lagophthalmos of various etiologies as an alternative to the tarsoraphy. Always we have to consider the frequency of applications, because repeatedly used derivate of this neurotoxine causes irreversible changes in cutaneous and subcutaneous tissue.

Key words:
Botulotoxine A, entropium, histology, ptosis, treatment side effect


1. Brin, M.F., Boodhoo, TI, et. al.: Safety and tolerability of onabotulinumtoxin A in the treatment of facial lines: a meta-analysis of individual patient data from global clinical registration studies in 1678 participants. J Am Acad Dermatol, 61; 2009: 961–970.

2. Choi, J.C., Lucarelli, M.J., Shore, J.V.V.: Use of botulinum toxin A in pacients at risk of wound complications following eyelid reconstruction. Ophthal Plast Reconstr Surg, 13; 1997: 259–264.

3. Clark, G.T.: The management of oromandibular motor disorders and facial spasm with injections of botulinum toxin. Phys Med Rehabil Clin N Am, 14; 2003: 727–748.

4. Costa, P.G., Saraiva, F.P., et al.: Comparative study of Botox injection treatment for upper eyelid retraction with 6-moth follow-up in patients with thyroid eye disease in the congestive or fibrotic stage. Eye, 223; 2009: 767–773.

5. Crouch, E.R.: Use of botulinum toxin in strabismus., Curr Opin Ophthalmol, 17; 2006: 435–440.

6. Dressler, D., Wohlfahrt, K., et al.: Antibody-induced failure of botulinum toxin a therapy in cosmetic indication. Dermatol Surg, 36; 2010, Suppl. 4: 2182–2187.

7. Eston, J.S., Russel, B.W.: Effect of treatment with botulinum toxin on neurogenic blepharospasm. Brit Med J, 290; 1985: 1857–1859.

8. Gedrange, T., Gredes, T., et al.: Histological changes and changes in the myosin mRNA content of the porcine masticatory muscles after masseter treatment botulinum toxin A. Clin Oral Investig, 2012, Springer, (v předstihu publikováno na PubMed).

9. Gerinec, A., Slyško, P., Fišerová, O.: Prinos botulotoxínu v liečbě strabizmu. Čes a Slov Oftal, 54; 1998: 174–178.

10. Grandas, F., Elston, J., et al.: Blepharospasm: a review of 264 patients. J Nerol Neurosurg Psychiat, 51; 1988: 767–772.

11. Gumus, K., Lee, S., et al.: Botulinum toxin injection for the management of refractory filamentary keratitis. Arch Ophthalmol, 130; 2012: 446–450.

12. Hayton, MJ., Dantini, A.J., et al.: Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am, 87; 2005: 503–507.

13. Klein, A.V.V.: Botox for the eyes and eyebrows. Dermatol Slin, 22; 2004: 145–149.

14. Kowal, L., Wong, E., Yahalon, C.: Botulinum toxin in the treatment of strabismus. A review of its use and effects. Disdabil Rehabil, 23; 2007: 1823–1831.

15. Lueder, G.T., Galli, M., et al.: Long-term reset of botulinum toxin-augmended medial rectus recessions for large-angle infantile esotropia. Am J Ophthalmol, 153; 2012: 560–563.

16. Naik, M.N., Gangopadhyay, N., et al.: Anterior chemodenervation of levator palpebrae superioris with botulinum toxin type-A (Botox) to induce temporary ptosis for corneal protection. Eye, 22; 2008: 1132–1136.

17. Niautu, J. 3rd: Complications in Fillers and Botox. Oral. Maxillofac. Surg Clin North A, 21; 2009: 13–21.

18. Niautu, J. 3rd.: Botulin toxin A: a review of 1.085 oral and maxillofacial patient treatments. J Oral Maxillofac Surg, 61; 2003: 317–324.

19. Otradovec, J.: Klinická neurooftalmologie, Grada, Praha, 2003, s. 339.

20. Paloma, V., Samper, A.: A complication with the aesthetic use a Botox: Herniation of the orbital fat. Plast Reconstr Surg, 107; 2001: 1315.

21. Pagen, F.L., Harrison, A.: A guide to dosing in the treatment of cervical dystonia and blepharospasm with XeominR: new botulin neurotoxin A. Parkinsonism Relat. Disord., 18, 2012: 441–445.

22. Prado, A., Fuentes, P., et al.: Pseudoaneurysm of the frontal branch of the superfacial temporal artery: an unusual complication after the injection of Botox. Plast. Reconstr. Surg., 119, 2007: 2334–2335.

23. Prager, W., Huber-Vorländer, J., Taufig, A,Z.. et al.: Botulinum toxin type A treatment to the upper face: retrospective analysis of daily practice. Clin Cosmet Investig Dermatol, 5; 2012: 53–56.

24. Reddy, U.P., Woodward, J.A.: Abobotulinum toxin A (Dysport) and botulinum toxin type A (Botox) for purposeful induction of eyelid ptosis. Ophthal Plast Reconstr Surg, 26; 2010: 489–491.

25. Remeš, F., Roth, J., Růžička, E.: Léčebné použití Botulotoxinu v neurologii. Prakt Lék, 74; 1994: 174–177.

26. Roehm, P.C., Perry, J.D. et al.: Prevalence of periocular depigmentation after repeated botulin toxin A injections in African American patients. J Neroophthalmol, 19; 1999: 7–9.

27. Rousseaux, M., Buisset, N., et al.: Comparison of botulinum toxin injection and nerotomy in patiens with distal lower limb spasticity. Eu J Neurol, 15, 2008: 506–511.

28. Rowe, F.J., Noonan, C.P.: Botulin toxin for the treatment of strabismus. Cochrane Database Syst. Rev., 2012, Ef. 15:2: CD006499.

29. Růžička, E., Roth, J., Diblík, P.: Botulotoxin v léčbě blefarospazmu. Čas Lék čes, 131; 1992: 213–216.

30. Scott, AB.: Botulinum toxin injections into extra-ocular muscles as an alternative to strabismus surgery. Ophthalmology, 87; 1980: 1044–1049.

31. Scott, A.B., Kennedy, R.A., Stubbs, H.A.: Botulinum toxin injection as treatment for blefarospasm., Arch. Ophthalmol., 103; 1985: 347–350.

32. Vácha, J., Bodnár, M., et al.: Botulotoxín A – jedna z možností léčby strabismu. Folia Strabol Neuroophtalmol, 6; 2003, Suppl. 1.: 50–51.

33. Vartanian, A.J., Davan, S., H.: Complications of botulinum toxin A use in facial rejuvenation., Facial. Plast. Surg. Clin North Am, 11; 2003: 483–492.

34. Wabbels, B., Reichel, G., Fulford-Smith, A. et al.: Double-blind, randomized, parallel group pilot study comparing two botulinum toxin type A products for treatment of blepharospasm. J Neural Trans, 118; 2011: 233–239.

35. Winner, P.K., Sadowsky, C.H. et al.: Concurrent Onabotulinum toxin A treatment of cervical dystonia and concomitant migrace. Haedache, 18; 2012: 15 - 26.

36. Wojno, T.H.: Results of lacrimal gland botulinum toxin injection for epifora in lacrimal obstruction and gustatory tearing. Ophthal Plast Reconstr Surg, 27; 2011: 119–121.

37. Yoon, J.S., Kim, J.C., Lee, S.Y.: Double-blind, randomized, comparative study of Medoxin versus Botox in the treatment of essential blepharospasm. Korean J Ophthalmol, 23; 2009: 137–141.

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