How is botulinum A toxin administered in the treatment of benign essential blepharospasm (BEB)?

Updated: May 20, 2019
  • Author: Robert H Graham, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Meticulous technique in the administration of botulinum toxin helps ensure reliable and consistent results. BOTOX® should be hydrated with 0.9% nonpreserved saline, which should be introduced slowly into the vacuum-sealed vial to prevent frothing. If there is no vacuum in the BOTOX® bottle, it should not be used. Once reconstituted, the solution should be used immediately or kept refrigerated.

At the first treatment, use of a total dose of no more than 25 units per eye, divided among 4-6 periocular injection sites is recommended to avoid adverse effects. Subsequent treatments should be adjusted depending on patient response to the initial doses. [54] At each site, inject 2.5-10 units of BOTOX®. Use of lower volumes (higher concentrations) is suggested to avoid the risk of spread to adjacent areas. The solution should be injected subcutaneously over the orbicularis oculi and intramuscularly over the thicker corrugator and procerus muscles. Patients may return home without restrictions of activity. Most patients require repeated treatment every 3 months, but this ranges from 1-5 months.

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