The good toxin: 10 years of experience with botulinum toxin A in the treatment of benign essential blepharospasm

Purpose: To describe the efficacy and safety of botulinum toxin A (Botox) in patients with benign essential blepharospasm. Methods: Retrospective review of operation, injection, and medical records. Results: Information of 29 patients (nine males) was reviewed, and the average age of benign essential blepharospasm onset was 59.1 years. The average number of injections per patient was 14.2 +/- 8.2 (5-44) and the average follow-up was 75.8 +/- 47.3 months (15-180). The average unit dose was 14.2 +/- 8.2 (10-30) ipsilaterally in the patient's first year and was 21.4 +/- 5.0 (12.5-30) ipsilaterally in their last year (p = 0.00458). The average onset time was 3.8 +/- 1.9 (1-7) days in a patient's first year and was 3.6 +/- 1.7 (2-7) days in their last year (p = 0.549). The average effective duration was 2.86 +/- 1.1 months in a patient's first year and was 2.53 +/- 0.9 in their final year (p = 0.187). The Subjective Spasm Alleviation Scale was 1.72 +/- 0.4 at the first year and was 1.79 +/- 0.5 in the last year (p = 0.187). Ten (34.5%) patients with eyelid disease had surgical correction. The Subjective Spasm Alleviation Scale was 1.50 +/- 0.5 before and was 2.0 +/- 0 six months after the operation (p = 0.0268). Post-injection complications were experienced in eight (27.6%) patients. The most common complication was ptosis (n = 7), followed by diplopia (n = 1), dry eye (n = 1), and tearing (n = 1). No life-threatening complication was reported. Conclusion: Botox was a safe and effective treatment in benign essential blepharospasm which required an increased dosage over time. Ptosis was the most common complication and no life-threatening condition was reported. Surgical correction of those with eyelid diseases showed subjective improvement of subsequent Botox treatment.