Comment j'examine et prends en charge les effets indésirables des injections palpébrales de toxine botulique

Injections of botulinum toxin in the orbicularis oculi muscle - for treatment of blepharospasm and hemifacial spasm mainly - can be complicated by various side effects, such as lagophthalmos, diplopia, blurred vision, ptosis, lacrimation, dry eye, edema or ecchymosis. The most frequent problem in our department was an impairment of tear secretion (up or down). Good anatomical knowledge is necessary to understand and avoid these side effects. In most cases, it is necessary to reduce the dose of botulinum toxin, although any reduction has to be carefully conducted (i.e., in which part(s) of the muscle do I have to reduce the dose?) to achieve sustained efficacy. It is also sometimes useful to vary the drug concentration. Finally, it is always necessary to check concomitant treatments; e.g. aminoside antibiotherapy can induce hypersensitivity to botulinum toxin.