Abstract

DO.19.10

Botulinum toxin therapy in ophthalmology – State of the art

Wabbels B.
Universitäts-Augenklinik Bonn

In ophthalmology, botulinum toxin has first been applied in the seventies for treatment of strabismus. Currently the main application in ophthalmology is the treatment of blepharospasm (essential blepharospasm and hemifacial spasm). In essential blepharospasm, 90-95% of patients have good therapeutic effect in long-term follow-ups. There are many other (less frequent) indications, where botulinum-toxin has been proven effective in ophthalmology: Sixth nerve palsy, Graves disease (restrictive strabismus or upper eye lid retraction), praeoperative eye muscle injection in order to test double vision after squint surgery, synkinesia following facial paralysis, protective ptosis in lagophthalmos or to treat corneal ulcers, “crocodile tears”, spastic entropium or chronic irritations of the anterior segment after radiation. Therapeutic products are Botox^®, Dysport^® and Xeomin^®. In case of an insufficient therapeutic response, botulinumtoxin type B may be used (Neurobloc^®). For many of the mentioned less frequent indications, treatment is an off label use. Increasingly, botulinum-toxin is also used for cosmetic indications as periorbital or forehead wrinkles. So the number of possible applications of botulinum toxin in ophthalmology (as in the whole medical field) has increased markedly during the last years.

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