Objective: This study explores botulinum toxin (BT) injection techniques to optimize outcomes for patients with facial disorders, focusing on improving dry eye.

Background: Dry eye is often pre-existing in facial disorders (e.g., blepharospasm, hemifacial spasm, post facial paralysis synkinesis) and a less frequent side effect of BT injections. Medial lower eyelid injections have been shown to improve dry eye, though concerns exist about potential diffusion causing diplopia.

Method: A retrospective study of patients who received BT treatment between 2020–2024 was conducted. Patients were assessed using the CGI-S, HFS7 questionnaire, Dry Eye Questionnaire 5 (DEQ5), and Visual Analogue Scale (VAS). Lower eyelid injections targeted either the midpoint or the medial area. Sixty-six patients participated in 437 therapeutic cycles (HFS: 193, PFPS: 146, BS: 86).

Results: Over time, CGI-S and HFS7 decreased dramatically while VAS increased up to a mean of 80.1±23.3, highest in the HFS group and lowest in the PFPS (p=0.005). Dry eye complaints were frequent, with 51.4% classified as having dry eye (DEQ5≥6) before the medial approach. Total DEQ5 score decreased from 8.8±4.2 in the first visit to 4.3±3.7 in the 5^th visit (p=0.03) in patients treated with the medial approach. No cases of diplopia were reported in either approach. BT is effective for treating facial disorders.

Conclusion: Medial lower eyelid injections improve dry eye and extend the duration of therapeutic effects without increasing the risk of side effects like diplopia, making them superior to midline injections in the lower eyelid.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/lower-eyelids-botulinum-injections-improving-dry-eye-and-prolonging-therapeutic-effect/