Five decades of the use of botulinum toxin in ophthalmology

Abstract

Botulinum toxin (BoNT) has been known for over 50 years. It has conquered many areas of medicine and has become indispensable in contemporary medicine. Now, BoNT is used to treat at least 26 conditions in six medical specialties. Although the use of BoNT began in strabology, it became the gold standard for many ophthalmologic pathologies. The present review of the literature focuses on the use of BoNT in ophthalmology and treatment of the following conditions: blepharospasm, facial hemispasm, facial palsy, spastic entropion, strabismus, endocrine orbitopathy, convergence spasm, and facial trauma. We conclude that nearly half a century of experience in utilizing BoNT in ophthalmology ensured a satisfactory level of effectiveness and safety for patients with many pathologies. Areas of future research include the application of BoNT in new selected indications, the development of the route of application without injections, and the development of long-acting BoNT forms for patients who require repeated long-term treatment.

Figure 1

Botulinum neurotoxin injections for essential blepharospasm – site of injections into the musculus orbicularis oculi (a–d)

Figure 2

Diagram of the sites of injections and doses of botulinum toxin used in ophthalmology

Figure 3

Botulinum neurotoxin injection sites for crocodile tears (a), protective ptosis (b), and for reducing the lid retraction in endocrine orbitopathy (c)