Botulinum A toxin for (expressionistic) ptosis overcorrection after frontalis sling

Area of Science:

• Ophthalmology
• Neurology
• Plastic Surgery

Background:

• Patients with third nerve palsies may experience intermittent upper eyelid retraction, particularly during facial movements.
• This retraction can occur post-frontalis sling procedure due to occipitofrontalis muscle contraction.
• Assessing and managing dynamic eyelid abnormalities is crucial for patient outcomes.

Observation:

• Two patients with complete third nerve palsies underwent Botulinum A toxin injections into the frontalis muscle.
• The injections aimed to limit upper eyelid retraction associated with facial expressions.
• Upper eyelid position was evaluated during both active facial movement and at rest.

Findings:

• Botulinum A toxin injections successfully corrected intermittent upper eyelid retraction during facial animation.
• Eyelid position remained stable when facial muscles were at rest, with no adverse effect on baseline lid height.
• Patients experienced improved cosmesis and reduced intermittent ocular exposure.
• A localized blunting of forehead creases was observed, demonstrating the toxin's localized denervation effect.

Implications:

• Botulinum A toxin offers a targeted treatment for dynamic upper eyelid retraction in specific neurological conditions.
• This approach can enhance both functional outcomes (ocular surface protection) and aesthetic results.
• Understanding the denervation field of botulinum toxin injections provides valuable clinical insights for procedural planning.