Botulinum toxin treatment for protecting the eye surface (to cause drooping of eyelid)

What is the effect of botulinum toxin?

Botulinum toxin causes a temporary, partial or complete, paralysis (weakness) of the muscle into which it has been injected. Botulinum toxin can be used to lower the upper lid, so that the eye is closed and the cornea (clear window of the eye) is protected.

Will botulinum toxin affect my general health?

The treatment is safe and there is no risk of developing botulism or food poisoning. Wehave never had a patient experience any general health problem due to botulinum, but all medication carries a small potential risk of a serious allergic reaction (anaphylaxis). Thereis no known risk when the treatment is given to women who are pregnant or breastfeeding, but some patients prefer to postpone treatment until they have given birth or weaned their child.

What will happen when I attend the clinic?

If the treatment is suitable for you, you will be asked to read and sign a consent form, and you will usually receive the treatment on the same day in the clinic. You should expect to be in the clinic for the whole morning or afternoon.

What is the treatment procedure?

The eye lid skin will be cleaned with a swab, and a small injection is given slowly into the upper eye lid. This is usually tolerated well and takes less than a minute.

What happens after the injection?

You will be able to go home after the injection. Youmay feel an ache in the injected area and you can take a painkiller if necessary.

When should I expect to see an effect from the treatment?

The effect is usually noticed about two– three days after the injection is given. If the effect is insufficient, a repeat injection may be required.

How long does the effect last?

This can vary: the maximum effect usually lasts two–five weeks, but can take up to 28 weeks to wear off. You may require further treatment depending on the health of your cornea and the effectiveness of the initial injection.

What are the possible side effects?

Most side effects are temporary and recover with time. Potential side effects include:

• Temporary double vision – you should not drive whilst you have double vision. It is very important that you discuss this with the doctor before treatment if this is of particular concern to you (see DVLA website: double vision and driving)
• Bruising of the eyelid
• Occasional cases of permanent residual lid closure or droop and double vision have been reported.
• In extremely rare cases, an injection around the eye could cause serious side effects to the eye or vision due to infection or bleeding.

When do I return to the clinic?

You will have an appointment made to return to the clinic to check the injection has worked and the health of your cornea – when you return will depend on your individual need.

Any other important information I should know?

Botulinum toxin has been used for treating eye conditions at Moorfields since 1982 andfor eyelid closure since the 1990s.

Although botulinum toxin was originally introduced for the treatment of squint in 1979 (with our clinics successfully treating patients since 1982), the manufacturers have neverapplied for a drug product licence. We use it on a ‘named patient’ basis, and records are kept of all injections and patient details. This is one of many examples of a drug with aproduct licence for one condition being used safely and successfully for another condition.

If you are unclear about any aspect of this treatment or have any questions, please ask the doctor to explain further.

Author: Mark Wilkins, corneal service director

Revision date: January 2020