Oman Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2010  |  Volume : 3  |  Issue : 3  |  Page : 158--159

Lower lid entropion correction with botulinum toxin injection


Amarendra Deka, SP Saikia 
 Department of Oculoplasty, Bawri Nethralaya, Shillong, India

Correspondence Address:
Amarendra Deka
Bawri Nethralaya, Butcher Road, Cantonment Bunglow No. 40, Shillong 793 001
India




How to cite this article:
Deka A, Saikia S P. Lower lid entropion correction with botulinum toxin injection.Oman J Ophthalmol 2010;3:158-159


How to cite this URL:
Deka A, Saikia S P. Lower lid entropion correction with botulinum toxin injection. Oman J Ophthalmol [serial online] 2010 [cited 2020 Jul 10 ];3:158-159
Available from: http://www.ojoonline.org/text.asp?2010/3/3/158/71909


Full Text

Sir,

Entropion is the inward turning of the eyelid and is most commonly seen as an aging phenomenon produced by attenuation or detachment of the lower eyelid retractor and associated with horizontal eyelid laxity. Although surgical treatment is more reliable and remains the treatment of choice, various medical treatments such as tissue glue and botulinum toxin have been advocated.

We report the results of treatment of lower lid entropion with botulinum toxin A.

Seventeen patients with senile entropion, one patient with congenital entropion and two patients with congenital entropion with corneal epithelial defect were included for this study. Patients were explained about the effect and side effects of the toxin. Informed consent was taken.

All the cases had entropion more than 6 months, and two patients had previous entropion surgery. Thirteen patients that included two children had bilateral entropion.

The toxin (Botox® , Allergan Corporation, Irvine, CA, USA) that was supplied in a vial contained 100 units of freeze-dried botulinum toxin A. This was reconstituted and diluted with 2 mL of saline to make it five units in 0.1 ml. The reconstituted toxin was injected subcutaneously [1] over the orbicularis oculi muscle about 3-4 mm below the eyelash margin of lower lid at three sites with a 30-gauge needle attached to a 1-mL syringe. Most of the patients were re-examined daily for 1 week, then biweekly for 6 months to know the duration of relief. The ethics review board of Bawri Nethralaya approved this study [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

In 19 patients including one case that had previous surgery, improvement was immediate and sustained. However, one other patient who had previous entropion surgery did not improve as expected. The volume on toxin that tended to pull the eyelash margin away from the globe resulted in immediate improvement. The actual effect on the eyelid margin was visible within 3 to 4 days of infection. The duration of improvement varied from 8 to 16 weeks. However, a 4-year-old child showed sustained improvement for a period of 26 weeks [Table 1]. Corneal defects in two children healed following correction of entropion. No side effect was noticed.{Table 1}

Botulinum toxin A is an exotoxin produced by Clostridium botulinum, a gram-positive anerobic bacterium. The toxin inhibits the release of acetylcholine at neuromuscular junctions affecting temporary paralysis of targeted muscle. Recovery of muscle action occurs because of axonal sprouting and formation of new neuromuscular junction. [2],[3]

Although surgical correction of senile entropion is definitive and permanent, botulinum toxin injection results in temporary correction of senile entropion as documented in a previous study. [1],[4] It is a safe and quick outpatient procedure, results in temporary but immediate improvement of the condition. The toxin has a longer effect in patients with less lower lid laxity. [1]

In summary, although surgical treatment should be the choice of treatment for entropion, botulinum toxin is a safe and effective procedure for correction of some cases of senile and congenital entropion. It is very useful in children having congenital entropion with corneal defect, where immediate improvement is essential. [5]

References

1Steel DH, Hoh HB, Harrad RA, Collins CR. Botulinum toxin for the temporary treatment of involutional lower lid entropion: A clinical and morphological study. Eye 1997;11:472-5.
2Dutton JJ. Botulinum-A toxin in the treatment of craniocervical muscle spasms: Short- and long-term, local and systemic effects. Surv Ophthalmol 1996;41:51-65.
3Holds JB, Fogg SG, Anderson RL. Motor nerve sprouting in humen orbicularis muscle after botulinum A injection. Invest Ophthalmol Vis Sci 1990;31:964-7.
4Clarke JR, Spalton DJ. Treatment of senile entropion with botulinum toxin. Br J Ophthalmol 1988;72:361-2.
5Christiansen G, Mohney BG, Baratz KH, Bradley EA. Botulinum toxin for the treatment of congenital entropion. Am J Ophthalmol 2004;138:153-5.