Treatment of blepharospasm with high dose brow injection of botulinum toxin.

We treated 12 patients who had essential blepharospasm with brow and eyelid injections of botulinum toxin. The eyelid injections were kept constant while varying doses were used in the brow. The duration of the effect of the toxin was longer and the degree of improvement greater in those patients receiving more than 20 U in the brow than in those receiving less than 20 U. However, the degree of improvement in spasm intensity in those patients receiving greater than 20 U was similar. Ptosis occurred in seven patients. No systemic side effects were noted.

Infracanalicular full-thickness transverse blepharotomy for medical ectropion.

Procedures performed for total lid ectropion often fail to correct medial ectropion of the lower eyelid. Described herein is a technique of infracanalicular full-thickness transverse blepharotomy using rotational sutures for the treatment of medial ectropion. This procedure has been very useful for recurrent medial ectropion and also as a primary procedure. Concomitant canthal laxity should also be corrected.

Posttraumatic convergence insufficiency.

Convergence insufficiency was encountered following closed head trauma in 23 patients. The most common complaints included difficulty reading and diplopia at near. The severity of the head trauma varied. There was no correlation between the severity of the head trauma and the severity of the convergence insufficiency. A normal near point of convergence was encountered in six of the 23 patients; all six patients had abnormal convergence reserves when measured with prisms. Treatment consisted primarily of convergence exercises and prisms. Bilateral medial rectus resections were required in two patients. Response to therapy was variable and often incomplete. The anatomic localization of convergence insufficiency secondary to head trauma remains unknown, although lesions in the occipital lobe and upper midbrain both seem capable of producing this syndrome.

Recurrent intraoperative choroidal effusion in Sturge-Weber syndrome.

The formation of a massive choroidal effusion without hemorrhage during a trabeculectomy procedure was documented in a 17-year-old male with Sturge-Weber syndrome, most probably representing the youngest patient in the literature with this intraoperative complication. The occurrence of similar signs during a previous trabeculectomy procedure in the same eye, suggested the possible recurrent nature of this entity. Preparation of a posterior sclerotomy site before entering the eye during intraocular surgery in patients with Sturge-Weber Syndrome might help in the immediate management and in preventing complications due to the formation of massive choroidal effusion.

Blepharoptosis in myasthenia gravis.

We reviewed the records of 23 patients with systemic myasthenia gravis and blepharoptosis. The overall prognosis for improvement of blepharoptosis in these patients was favorable when multiple modes of therapy, including anticholinesterase medication, were used. Four of five patients with disabling blepharoptosis were stable enough after three to four years of their disease to consider corrective lid surgery. Two patients underwent levator resection with good results. Patients with systemic and ocular myasthenia gravis who are refractory to systemic therapy should be considered candidates for ptosis surgery when their blepharoptosis has been stable over a three- to four-year period.