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Botulinum toxin in Ophthalmic Practice Dr Sunayana Bhat Consultant Paediatric ophthalmology, Strabismus and Neuro ophthalmology Vasan eye care, Mangalore.

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Presentation on theme: "Botulinum toxin in Ophthalmic Practice Dr Sunayana Bhat Consultant Paediatric ophthalmology, Strabismus and Neuro ophthalmology Vasan eye care, Mangalore."— Presentation transcript:

1 Botulinum toxin in Ophthalmic Practice Dr Sunayana Bhat Consultant Paediatric ophthalmology, Strabismus and Neuro ophthalmology Vasan eye care, Mangalore Ph :

2 Botulinum toxin injections are the fastest-growing cosmetic procedure all over the world Neurotoxin : Bacterium Clostridium botulinum 'botulus' sausage German physician who described the poisoning after the ingestion of sausage.

3 Mechanism of action Activity and dosing Clinically available forms Uses Complications

4 Mechanism of action Heavy chain of 100 kDa Light chain of 50 kDa 150 kDa core type A molecule

5 Mechanism of action ENDOCYTOSIS SUBSTRATE MODIFICATION

6 Mechanism of action Differ in SNARE protein / cleavage site A,B,C,D,E,F PROCESS OF FUNCTIONAL RECOVERY Sprouting of nerve fibers from the terminal axons Extra junctional Ach receptors

7 Activity and Dosing 1 unit : LD50 female swiss webster mice, intra peritoneal injection 1 unit : 0.05 ng of toxin Stored dry Reconstitution with saline 5-10 u : 0.1 ml

8 Commercial Preparations

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10 Benign Essential Blepharospasm Functional blindness : Episodic Spasms Effective in 75% 2.5 u each site … Subcutaneous Sites :

11 Stabismus : Muscle Inj Post paralytic ( prevent contractures ) With transpositions : for horizontals Dysthyroid orbitopathy Surgical surprises ! Infantile ET ??? Buying time

12 Nystagmus / Oscillopsia The "ideal" patient for retrobulbar Botox -restricted movement -oscillopsia, -willing to use only one eye.

13 Chronic Dry Eyes Medial orbicularis muscle : inj failed lacrimal pump Subjective improvement of symptoms in 70% of cases

14 Post Peripheral Facial Nerve Synkinesis Facial deformity Drooling Twitching / muscle spasms

15 Tics,Tremors and Myokymia Spontaneous discharges Known to resolve spontaneously 2.5 u

16 Elevated IOP due to Restrictive Myopathy Corneal Protective Ptosis Direct infiltration of levator muscle

17 Headache Syndromes Mechanism Relaxation of corrugator ? Nociceptive activity Frontalis Temporalis muscle on both sides Occipital muscle 50 – 100 u

18 Eyelid diseases Retraction graves disease Spastic Entropion Pre tarsal orbicularis overides -Ocular sx -Irritation

19 Compressive Optic Neuropathy Enlarged muscles : crowding Reduced contraction Reduced muscle bulk

20 Hyperhydrosis Lacrimal Hypersecretion syndromes 1% population Face, axilla, palms Frey syndrome : gustatory sweating Gustatory epiphora 2.5 U palpebral lobe of lacrimal gland 8 mm of schirmer value reduction

21 Aesthetic uses Forehead furrows Glabellar lines Lateral rhytides ( crows feet ) Brow lift Perioral rhytides ( smokers lines ) Mesolabial folds (marionette lines ) Platysmal bands

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23 ALL IS WELL………….

24 Complications Ptosis - always transient Induced deviations - usually transient Diplopia - transient Dilated pupil - rare Reduced accommodation - rare Scleral perforation* - rare - potentially serious Lip droop - very bothersome; may be persistent

25 Future Trends Antibody development …. Complication : anti globulin within 4 hrs Bioterrorism ……VACCINES ????.....

26 Thank u


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