The Application of Dysport^® – the Possibilities of the Side Effect on the Eyelids Position (a Clinical – Histological study)

Czech version

Authors: J. Krásný; J. Šach
Authors‘ workplace: Ústav patologie 3. LF UK a FNKV, Praha, přednosta prof. MUDr. Václav Mandys, CSc. ; Oční klinika FNKV, Praha, přednosta prof. MUDr. Pavel Kuchynka, CSc.
Published in: Čes. a slov. Oftal., 68, 2012, No. 5, p. 216-220
Category: Original Article

Předneseno na XVI. Výročním sjezdu ČOS ve Špindlerově Mlýně, září 2008

Overview

Aim:
To inform about the possibility of negative influence of repeated application of the botulotoxine A derivate on the eye lid position with the changes of their tissue structure. At the same moment, the authors report on literature analysis of positive and negative influence of this neuro toxine from the medical point of view.

Materials and methods:
At the Department of Ophthalmology in the Faculty Hospital Královské Vinohrady, Prague, Czech Republic, E.U., there were surgically treated three patients after repeated applications of botulotoxine A derivates. The first case was bilateral ptosis of upper eyelids; the other two were indicated because of entropium with trichiasis of lower eyelids. In the medical history, there was recorded ten years lasting above-mentioned drug treatment for blepharospasm diagnosis in a 65 years old man introducing bilateral symmetrical ptosis. Because of the following frontal muscle involvement, and partial decreasing levator palpebrae muscles function, the positioning of the upper eyelids was treated by the aponeurosis plasty with good functional result. In two female patients, aged 72 and 90 years, the indication for successful surgical treatment was chronic entropium of lower eyelids; initially ineffectively treated by means of repeated intradermal injections of botulotoxin A derivates.

Results:
Histological examinations of the excided skin and subcutis samples taken during ectropium plasties showed unfavorable and irreversible changes including especially scarring of the eyelid and atrophy of the striated muscles.

Conclusion:
The indication of botulotoxine A derivates application should be carefully weighted and the proper indication should be chosen. From the ophthalmologic point of view, blefarospasmus only is the appropriate diagnosis, and the relative indication is the temporary induced ptosis of the upper eyelid closing the interpalpebral fissure to prevent corneal changes in lagophthalmos of various etiologies as an alternative to the tarsoraphy. Always we have to consider the frequency of applications, because repeatedly used derivate of this neurotoxine causes irreversible changes in cutaneous and subcutaneous tissue.

Key words:
Botulotoxine A, entropium, histology, ptosis, treatment side effect

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