Botulinum Toxin: A Non-surgical Approach for Non-myasthenic Mild-to-Moderate Blepharoptosis Treatment

Introduction: Mild-to-moderate blepharoptosis can be aesthetically displeasing for patients, particularly in cases involving a single eyelid. However, certain patients are reluctant to undergo surgical intervention. Botulinum neurotoxin A (BoNT-A) injection offers a potential solution in such cases.

Material and methods: Patients meeting the following inclusion criteria were included in the study: mild-to-moderate eyelid ptosis of different etiologies (excluding myasthenic disorders), robust activity of the orbicularis oculi muscle, proficiency in Italian language, standardized pre- and postoperative photo-documentation, and signed consent for study participation. A 32-33 Gauge 4-mm needle was employed to inject the BoNT-A in the pretarsal orbicularis muscle. Standardized videos and photos were obtained before the treatment, 2 weeks, 4 weeks, and 24 weeks post-treatment. Outcomes were evaluated by measuring changes in the margin reflex distance-1 (MRD-1) and assessing patient point of view through two subjective questionnaires.

Results: Forty-nine patients were enrolled, 39 females and 10 males, aged between 30 and 88 years old. We observed a significant increase in the MRD-1 after 2 weeks and after 4 weeks compared to the baseline (p < 0.0001), with a mean elevation of the eyelid of 0.71 mm and 0.67 mm respectively. Patients ceased to require furrowing of the frontalis muscle to compensate for the eyelid elevation dysfunction. After 24 weeks, the BoNT-A effect diminished, and the treated eyelid returned to its baseline position. 67.4% of patients reported an improvement with only mild inconvenience in their blepharoptosis, and 16.3% of patients reported a complete improvement. 85.7% of patients expressed the desire to undergo the treatment again.

Conclusions: BoNT-A has demonstrated effectiveness in temporarily managing mild-to-moderate blepharoptosis and may represent a viable option for addressing minor eyelids asymmetries.

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