Neurological Sciences

, Volume 35, Issue 3, pp 397–400 | Cite as

The combined treatment with orbital and pretarsal botulinum toxin injections in the management of poorly responsive blepharospasm

  • Marcello Esposito
  • A. Fasano
  • C. Crisci
  • R. Dubbioso
  • R. Iodice
  • Lucio Santoro
Original Article


Blepharospasm (BS) is a focal dystonia involving involuntary contractions of muscles around the eyes. Botulinum toxin (BoNT) is the most effective treatment for BS and the technique of injection changes depending on the clinical picture. Usually typical BS benefits from the injection in the orbital part of the orbicularis oculi (OOc) muscle (orbital injection), while BoNT injection in the pretarsal part of OOc muscle is helpful especially for the atypical BS (opening eyelid apraxia). The aim of this study was to compare the efficacy of two injection techniques, the orbital versus the combined (injection in both orbital and pretarsal part of OOc) in BS patients with unsatisfactory response to BoNT. Nineteen patients with typical BS not having a satisfactory response from BoNT treatment with the orbital injection (primary and secondary resistant patients) were studied. After 3 months from the last orbital injection patients received the combined injection; they were assessed with the JRS and BSDI scales after 4 weeks from the last orbital and the first combined injection. Statistical analysis showed a significant reduction (p < 0.05) of the mean score of JRS and BSDI scales comparing the combined with orbital injection. This study shows that the treatment of typical BS can have better results when BoNT is injected with the combined technique in primary and secondary resistant patients.


Botulinum toxin Blepharospasm Pretarsal Orbital Resistant 



The authors do not have financial disclosures or conflict of interest concerning the research related to the manuscript. There are no funding sources for this study.


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Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Marcello Esposito
    • 1
  • A. Fasano
    • 2
  • C. Crisci
    • 3
  • R. Dubbioso
    • 1
  • R. Iodice
    • 1
  • Lucio Santoro
    • 1
  1. 1.Department of Neurological SciencesUniversity Federico II of NaplesNaplesItaly
  2. 2.Division of Neurology, Movement Disorders Center, TWH, UHNUniversity of TorontoTorontoCanada
  3. 3.Neurorehabilitation DepartmentClinic CenterNaplesItaly

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