Botulinum Toxin (Botox)

Botulinum toxin (brand names Botox, Dysport, Xeomin) is a neurotoxin that temporarily weakens muscles. In neuro-ophthalmology, it's used to treat blepharospasm, hemifacial spasm, and some cases of strabismus (crossed eyes).

How It Works

Botulinum toxin blocks the release of acetylcholine at the nerve-muscle junction, preventing muscle contraction. This temporarily weakens the injected muscle, reducing spasms.

Common Uses

• Blepharospasm—involuntary eyelid closure
• Hemifacial spasm—one-sided facial twitching
• Strabismus (certain cases)
• Eyelid retraction
• Cosmetic uses

Administration

• Injected directly into affected muscles
• Small needles, minimal discomfort
• Takes about 10-15 minutes
• Repeat every 3-4 months typically

Expected Results

• Effects begin within 2-7 days
• Peak effect at about 2 weeks
• Duration typically 3-4 months
• Effects gradually wear off

Side Effects

Common (Usually Temporary)

• Bruising at injection sites
• Temporary ptosis (droopy eyelid)
• Dry eye or tearing
• Temporary weakness of nearby muscles

Less Common

• Difficulty closing eyes (exposure keratitis)
• Double vision (if eye muscles affected)
• Headache

Tips for Best Results

• Don't rub injection sites for 24 hours
• Stay upright for 4 hours after injections
• Report concerns to your doctor
• Keep appointments for regular injections

Frequently Asked Questions

Does it hurt?

There's minimal discomfort—small needles are used. Some doctors use ice or numbing cream to reduce sensation.

How often will I need injections?

Typically every 3-4 months when effects wear off. Some patients can extend intervals over time.

Is it safe long-term?

Yes, botulinum toxin has been used for decades and has an excellent safety record. Most patients use it continuously for years.

Will I look different?

For blepharospasm treatment, the goal is reducing spasms, not changing appearance. Some temporary cosmetic effects (like brow position changes) may occur.