Botulinum Toxin Injections for eye conditions

What is Blepharospasm?

Blepharospasm is a condition that affects the blinking mechanism of your eyes. Patients with this condition often experience involuntary tightening of the muscles that control the eyelid, causing uncontrollable blinking which generally affects both eyes. Blepharospasm can diminish a patient’s ability to perform everyday activities by interfering with their ability to see and can severely affect quality of life.

What are the symptoms of Blepharospasm?

• Eye irritation
• Sensitivity to light
• Excessive blinking/twitching of the eye.

These signs may vary in severity at different times of the day or from day to day. You may find your condition may worsen with stress and tiredness.

Hemifacial Spasm 

 In this condition muscles on one side of the face twitch or flicker. The spasms often start around the eye and may spread to other muscles around the mouth or even down into the neck.

What are the symptoms of Hemifacial spasm?

• Dry eyes or watering eyes
• Light sensitivity
• Increased blinking
• Frequent eye/face twitching
• Discomfort to the face.

For some people, the spasms may become worse when they are tired and stressed.

What causes Blepharospasm and Hemifacial spasm?

The cause of Blepharospasm is not fully understood. In most patients there is no obvious cause and hence the condition is known as idiopathic Blepharospasm.

Botulinum Toxin Injections 

Botulinum toxin injections, such as Botulinum toxin A or Dysport, are medical treatments that have been used by doctors for the treatment of many muscle problems. The injections help to relax muscles and are therefore used for blepharospasm and hemifacial spasm to relax the muscles around the eyes. This reduces the involuntary closure of the eyes and helps patients to keep their eyes open when they want. 

What do Botulinum toxin injections involve?

Small amounts of botulinum toxin are injected into the muscles around the eye and into the eyelids for the eye/ eyes to be treated.

The injections needed, can vary in number, depending on the type and severity of the condition. The whole procedure can take up to two minutes to five minutes. The injections may be a little painful however; most people tolerate the discomfort well. The practitioner will advise you if any bruising has occurred instantly as it can be difficult to avoid in some patients.

What are the effects of the Botulinum toxin?

It takes about three to five days before the injections take effect, and up to two weeks for the full effect to be seen. You should then notice a reduction in the amount of spasm you have.

The effects of the Botulinum toxin generally last for three months and then can start to wear off. If the effect of the injections is to be maintained, repeated injections are needed. Usually these are repeated every three months.

Are there any side effects?

The side effects of Botulinum toxin treatment around the eyes relate to it working too well, or with regard to it leaking into other muscles round the eyes and causing them to become weakened.

All the side effects are temporary and will wear off as the Botulinum toxin wears off; consequently, they should resolve within three months. 

Side effects include:

• Poor Lid Closure of the eye or reduction in the blink reflex can result if the Botulinum toxin has worked too well and can result in dry eye with discomfort and blurry vision. Adding some lubricating drops can help during this time.
• A droopy upper lid, if the muscle holding up the eyelid is involved.
• Double vision, if the muscles moving the eye are involved.
• In addition, you may get some bruising at the injection sites. 

Very rarely, patients can develop resistance to the treatment, rendering it less effective.

Side effects usually disappear within a few days or weeks. Although rare, you should seek immediate medical advice if you develop any problems with swallowing, speaking or breathing (with or without swelling of the face, lips or tongue, redness of the skin or a lumpy rash) after botulinum toxin treatment.

Arriving at the Department

At your first visit all aspects of the treatment will be fully discussed between yourself and the practitioner and once you are satisfied with these discussions a consent form will need to be completed and you will receive a copy. If at any point during the discussion or once treatment is started you are uncomfortable or concerned, you can choose to stop the treatment.

If you are concerned about any side effects or you treatment plan, please call the Ophthalmology Unit on 01942 822244.