Objective: To compare the efficacy, patient satisfaction, and side effects between pretarsal and preseptal injection sites on BTX-A treatment in abnormal orbicularis oculi contraction in hemifacial spasm and blepharospasm.

Background: Hemifacial spasm and blepharospasm are common abnormal craniofacial movements that produce involuntary eyelid twitching and closure due to abnormal contractions of the orbicularis oculi muscle. An efficacy and safety of botulinum toxin type A (BTX-A) injections have been accepted and are widely used for treatment of both disorders. A difference of the injection sites around the orbicularis oculi may influence the effectiveness and side effects.

Methods: A total of 30 patients; 27 patients with hemifacial spasm, and 3 patients with blepharospasm participated in this study. Each patient received pretarsal or preseptal BTX-A injections with the usual dilution of 2.5 unit per 0.05 ml, and 2.5 unit at each point. Following a 3-month- washout period, subjects received the crossover treatment. Latency to response, peak of efficacy, side effects, duration of improvement, the Jankovic’s rating scale, the modified TWSTRS response scale, and patient satisfaction scale were assessed at 1 and 3 months after treatment.

Results: Pretarsal BTX-A treatment produced a significantly higher response rate in terms of latency to response (6.17 ± 3.45 vs 9.38 ± 8.12 days), peak of efficacy (16.34 ± 12.34 vs 21.10 ± 15.45 days), duration of improvement (10.34 ± 1.68 vs 9.55 ± 1.92 weeks), the Jankovic’s rating scale (1.17 ± 0.38 vs 1.52 ± 0.57), the modified TWSTRS response scale (3.72 ± 0.65 vs 3.34 ± 0.77), and patient satisfaction scale (8.07 ± 1.33 vs 7.00 ± 1.63) (p <0.05), without any significant difference of the cumulative BTX-A dose. Sixty-three percent of patients prefer a pretasal injection than a preseptal injection technique. In both groups of patients, minor side effects such as ecchymosis, pain and irritation at the injection sites were found in 15 percent, but major side effects such as ptosis were found only with preseptal injections (3/30).

Conclusions: These findings show that pretarsal BTX-A injection provides more efficacy, patient satisfaction, and less complication than preseptal BTX-A injection for treatment of involuntary eyelid twitching and closure in patients with hemifacial spasm and blepharospasm.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-crossover-study-of-pretarsal-and-preseptal-injections-of-botulinum-toxin-type-a-btx-a-in-the-treatment-of-hemifacial-spasm-and-blepharospasm/