The medical use of Botulinum toxin (BOTOX) is not new. In fact, it recently celebrated its 20th Anniversary! Microdoses of BOTOX were originally developed for folks with specific kinds of eye muscle problems. In specific clinical situations where one muscle was overpowering its partner muscle (think unbalanced suspenders) a tiny amount of BOTOX was injected to weaken the stronger muscle. All of this happened long before anyone thought about eliminating facial wrinkles.
Ophthalmologists have discovered a new way to use BOTOX to help with a serious neurologic problem affecting the eyes - Bell’s Palsy. This is paralysis of the Facial Nerve, the nerve that controls the muscles of facial expression including the muscles that close the eyelids (orbicularis oculi). Most cases are temporary. When Bell’s Palsy occurs the eyeball is threatened because the blink reflex is lost along with voluntary lid closure. The nerve that opens the eyelids is still intact, so the eye tends to stay open 24/7. Chronic exposure can lead to severe pain, loss of vision, and other serious complications that might lead to loss of the eye.
Patching and lubricants are usually inadequate to protect the eye, so surgery is often performed to partially or completely close the lids. The procedure is called a tarsorrhaphy and it has its own set of potential problems. So, this is where BOTOX offers a novel solution.
By injecting a tiny amount of BOTOX into the upper eyelid the muscle fibers that would ordinarily open the eyelids are paralyzed for 2-3 months. This temporary lid droop neutralizes the effects of the Bell’s Palsy, leaving the eyelid closed and the eye fully protected without the need for multiple surgical procedures.
By 3 months most folks with a temporary Bell’s Palsy recover good use of their Facial Nerve – about the same time the BOTOX wears off. Lid elevation and lid closure are both restored.