The use of botulinum toxin for lower lid entropion

Abstract

Various therapeutic options such as lid taping or lubricant ointment have been used to alleviate symptoms while waiting for definitive surgical treatment of lower lid entropion. A retrospective survey of 120 patients undergoing entropion surgery was undertaken to assess the adequacy of these interim measures. There was a mean waiting time often weeks during which most patients were provided with a combination of ointment and lid taping to provide symptomatic relief. Twenty patients (16%) were dissatisfied with their treatment regime and 52% of these patients developed corneal erosions. In the second part of the study, 22 patients were recruited in a prospective study to evaluate the efficacy and acceptability of botulinum toxin injection to the lower lid as a temporary measure to relieve involutional entropion while awaiting surgery. These were scored on a sliding scale from 0 (unbearable) to 10 (excellent). Results demonstrate that botulinum toxin brought symptomatic relief to all patients with an improvement in the effectivity and acceptability scores from 3.40 to 9.72 and from 2.39 to 9.47 respectively (p < 0.001). The mean duration of action of the toxin was 70 days. The authors believe that botulinum toxin injection to the lower lid provides a more effective and acceptable interim measure in relieving lower lid entropion by temporary paralysis of the overriding pre-septal orbicularis muscle.

Key Words:

• Entropion
• botulinum toxin
• lid taping
• corneal erosions