Safety and Efficacy of Upper Eyelid Orbicularis Oculi Botulinum Toxin in Patients with Synkinesis

Background: Chemodenervation is an important means of treating oral-ocular synkinesis, but upper eyelid treatment is avoided due to risk of blepharoptosis. Objective: To measure the change in eyelid position among patients with oral-ocular synkinesis who received botulinum toxin to the upper eyelid orbicularis oculi compared with those who received lateral and lower eyelid treatment alone. Methods: In this retrospective clinical study, patients were categorized as having received lateral and lower eyelid botulinum toxin alone or having received upper eyelid botulinum toxin (to the preseptal and orbital orbicularis oculi) along with lateral and lower eyelid treatment. Pre- and posttreatment margin to reflex distance 1 (MRD1), margin to reflex distance 2 (MRD2), and palpebral height were measured using Emotrics software and compared using t tests and regression analysis. Results: Twenty-five patients were included. Mean age was 48.7 years and 24% were male. Mean duration of paralysis was 29 months (range 9-360 months). Posttreatment resting MRD1 (3.36) was not significantly different than pretreatment resting MRD1 (3.43) for patients who received upper eyelid botulinum toxin (p value = 0.60). Conclusion: Botulinum toxin to the upper eyelid orbicularis oculi injected superficially in small, concentrated aliquots did not result in blepharoptosis and was effective in reducing oral-ocular synkinesis.