Princess Alexandra Eye Pavilion, Edinburgh, UK.
Moorfields Eye Hospital, London, UK.
Eye (Lond). 2022 Jun;36(6):1217-1221. doi: 10.1038/s41433-021-01587-x. Epub 2021 Jun 11.
Botulinum toxin (BTX) is useful for inducing temporary ptosis in patients with ocular surface disease. However, transcutaneous BTX often causes inadvertent superior rectus (SR) paresis. Furthermore, Muller's muscle is unaffected by transcutaneous BTX, resulting in lagophthalmos and incomplete ptosis.
We report a novel BTX injection technique, in which the upper lid is double everted over a Desmarres retractor, and BTX injected transconjunctivally at the superior aspect of Muller's muscle, where it lies close to levator palpebrae superioris.
In our series of 21 patients, one had inadvertent subcutaneous BTX and developed incomplete ptosis. The remaining 20 patients had complete ptosis within 48 h. No patients had SR underaction.
We conclude that transconjunctival BTX injection is safe, effective, and superior to transcutaneous BTX injection, because of the low risk of superior rectus underaction and incomplete ptosis.
肉毒毒素（BTX）可用于诱导眼表疾病患者暂时性上睑下垂。然而，经皮 BTX 常导致不经意间的上直肌（SR）麻痹。此外，Muller 肌不受经皮 BTX 影响，导致睑裂闭合不全和上睑下垂不完全。
我们报告了一种新的 BTX 注射技术，在上睑通过 Desmarres 牵开器双重翻转，在靠近提上睑肌的 Muller 肌的上表面经结膜注射 BTX。
在我们的 21 例患者系列中，1 例患者发生意外的皮下 BTX 并出现不完全上睑下垂。其余 20 例患者在 48 小时内完全出现上睑下垂。没有患者出现 SR 下运动。
我们得出结论，经结膜 BTX 注射是安全、有效且优于经皮 BTX 注射的方法，因为发生 SR 下运动不足和上睑下垂不完全的风险较低。
