Botulinum induced ptosis for the treatment of neurotrophic keratitis

Mohan RAMALINGAM, Nayan JOSHI, Jayasree Sankunni NAIR, Nadir Ali Mohamad ALI.

Department of Ophthalmology, RIPAS Hospital, Brunei Darussalam.

ABSTRACT

The main medical indications for botulinum toxin type A injections is to treat certain spasmodic muscle disorders. A 40-year-old Malay lady presented with a right lower motor neurone facial nerve palsy, and associated exposure keratitis and hypopyon, following excision of schwannoma. The keratitis resolved after treatment with lubricants and lateral tarsorraphy. Two months later, she presented with corneal ulcer and hypopyon, which did not respond to topical antibiotics. Complete ptosis was induced in the right eye using Botulinum Toxin type A trans-cutaneous injection to the superior palpebrae superiosis. Following the injection, the ulcer recovered gradually over a period of five weeks. This report illustrates an important role of Botulinum toxin A in the management of refractory exposure keratitis.

Keywords: Botulinum Toxin Type A, corneal ulcer, denervation, keratitis

Correspondence: Nayan JOSHI, Department of Ophthalmology, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. Tel: +673 2242424 Fax: +673 2242690, E mail: eyeman@brunet.com

Brunei Int Med J. 2011; 7 (1): 37-40