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Updated: Jan 26, 2026

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
Published on: November 9, 2016
Supramaximal doses of botulinum toxin for refractory blepharospasm
Richard L Levy1, Dalia Berman, Mona Parikh
1Neuro-ophthalmology Unit, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Purpose:
To investigate the response to supramaximal doses of botulinum toxin in patients with refractory blepharospasm.
Design:
Prospective, nonrandomized, open-label interventional case series.
Participants:
Eight consecutive patients with blepharospasm requiring injections every 2 months despite receiving 100 U of botulinum toxin per session.
Intervention:
Increasing the dose of botulinum toxin per session above the conventional maximum.
Main Outcome Measures:
Duration of treatment effect and patients' subjective response to treatment.
Results:
Supramaximal dosages were well tolerated. Seven of 8 patients had a prolonged interval between injections relative to that associated with their previous dosing regimen. Four of the patients elected to continue with the new dosage.
Conclusion:
In select patients with essential blepharospasm who are refractory to standard treatment regimens, increasing the dosage of botulinum toxin above 100 U per session may decrease the interval between injections, improve the patient's quality of life, or both.
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