What are the possible complications of botulinum A toxin in the treatment of benign essential blepharospasm (BEB)?

Updated: May 20, 2019
  • Author: Robert H Graham, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Complications of botulinum toxin injections include ptosis (7-11%), corneal exposure/lagophthalmos (5-12%), symptomatic dry eye (7.5%), entropion, ectropion, epiphora, photophobia (2.5%), diplopia (< 1%), ecchymosis, and lower facial weakness. [52, 53] One of the more common adverse effects, ptosis, is due to diffusion of toxin from the upper eyelid injection sites to the exquisitely sensitive levator muscle. The incidence of ptosis has been reported as high as 50% of patients treated more than 4 times. In the hands of experienced injectors, the rate of complications such as ptosis is presumably less. Injection of botulinum toxin into the medial and lateral pretarsal orbicularis is usually sufficient to stop spasms for the duration of effect; avoiding central injections to the preseptal and preorbital orbicularis should help reduce the risk of ptosis.

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