OÊı·ÏÌÔÏÔÁ›· - Πανελλήνια Οφθαλμολογική Εταιρεία

∏ ¯Ú‹ÛË Ù˘ ·ÏÏ·ÓÙÔÙÔ͛Ӣ Ù‡appleÔ˘ ∞ ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛˤÏ͢ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ·applefi apple·Ú¿Ï˘ÛËÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘∫. MappleÔÌappleÔÚ›‰Ë˜, ¡. Zȿη˜ ∞. ∫ÔÛÎÔÛ¿˜, ¡. °ÂˆÚÁÈ¿‰Ë˜Botulinum toxin type A application in the management of upper lid retractionsecondary to facial nerve palsyK. Boboridis, N. Ziakas, A. Koskosas, N. Georgiadis∂ÈÛ·ÁˆÁ‹: ∏ ¤ÏÍË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ·applefi apple·Ú¿Ï˘ÛËÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘ ¤¯ÂÈ Û·Ó Û˘Ó¤appleÂÈ· ÙËÓ ÂÌÊ¿ÓÈÛËÏ·ÁfiÊı·ÏÌÔ˘, ÙËÓ appleÏËÌÌÂÏ‹ Î¿Ï˘„Ë ÙÔ˘ ÎÂÚ·ÙÔÂȉ‹ ηȉËÌÈÔ˘ÚÁ›· ÎÂÚ·Ù›Ùȉ·˜ ·applefi ¤ÎıÂÛË. ·ÚÔ˘ÛÈ¿˙Ô˘Ì ÙËÓÂÌappleÂÈÚ›· Ì·˜ ·applefi ÙËÓ ¯Ú‹ÛË Ù˘ ·ÏÏ·ÓÙÔÙÔ͛Ӣ Ù‡appleÔ˘ ∞ÛÙËÓ ·ÓÙÈÌÂÙÒappleÈÛË Ù˘ ¤Ï͢ ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ Ì ÙËÓ¯ËÌÈ΋ ·appleÔÓ‡ڈÛË ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Ì˘fi˜. ∞ÛıÂÓ›˜ –ª¤ıÔ‰Ô˜: ∏ ̤ıÔ‰Ô˜ ÂÊ·ÚÌfiÛıËΠ۠18 ·ÛıÂÓ›˜ ÌÂappleÚfiÛÊ·ÙË apple·Ú¿Ï˘ÛË ÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘, Û˘ÌappleÙˆ-Ì·ÙÈÎfi Ï·ÁfiÊı·ÏÌÔ Î·È ÎÂÚ·Ù›Ùȉ· ÂÍ ÂÎı¤Ûˆ˜ appleÔ˘ ‰ÂÓ·ÓÙ·appleÔÎÚ›ıËΠÛÙËÓ Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹ Ù¯ÓËÙÒÓ ‰·-ÎÚ‡ˆÓ. ªÂ ÙËÓ ¯Ú‹ÛË ‚ÂÏfiÓ·˜ ÈÓÛÔ˘Ï›Ó˘ appleÚ·ÁÌ·ÙÔappleÔÈ-‹ıËΠ¤Á¯˘ÛË 7,5-15 IU Botox ÛÙËÓ ÌÂÛfiÙËÙ· ÙÔ˘ ¿Óˆ‚ÏÂÊ¿ÚÔ˘, ·ÓÒÙÂÚ· ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘ ÙÔ˘ Whitnall, apple·Ú¿Ï-ÏËÏ· Î·È ¿Óˆ ·applefi ÙÔÓ ·ÓÂÏÎÙ‹Ú· Ì˘. ∫·Ù·ÁÚ¿ÊËÎ·Ó ÙÔ¿ÓÔÈÁÌ· Ù˘ ‚ÏÂÊ·ÚÈ΋˜ Û¯ÈÛÌ‹˜, ÙÔ Â‡ÚÔ˜ ÏÂÈÙÔ˘ÚÁ›·˜ÙÔ˘ ·ÓÂÏÎÙ‹Ú· Î·È ÙÔ ¿ÓÔÈÁÌ· ÙÔ˘ Ï·ÁfiÊı·ÏÌÔ˘ appleÚÈÓ Î·ÈÌÂÙ¿ ÙËÓ ¤Á¯˘ÛË ·Ó¿ Ù·ÎÙ¿ ‰È·ÛÙ‹Ì·Ù· ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜apple·Ú·ÎÔÏÔ‡ıËÛ˘. ∞appleÔÙÂϤÛÌ·Ù·: μÂÏÙ›ˆÛË ÙÔ˘ Ï·Áfi-Êı·ÏÌÔ˘ Î·È appleÚÔÛÙ·Û›· ÙÔ˘ ÎÂÚ·ÙÔÂȉ‹ ÂappleÈÙ‡¯ıËΠÛÂfiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∏ ¤ÏÍË ÙÔ˘ ¿Óˆ ‚ÏÂÊ¿ÚÔ˘ ‰ÈÔÚıÒıËÎÂÌ ı¤ÛË ÙÔ˘ ‚ÏÂÊ·ÚÈÎÔ‡ ¯Â›ÏÔ˘˜ ηÙÒÙÂÚ· ·applefiÙÔ ¿Óˆ ∫O, ÂÓÒ Û ‰‡Ô ÌfiÓÔÓ ·ÛıÂÓ›˜ Î¿Ï˘appleÙ ÙÔÓ Ô-appleÙÈÎfi ¿ÍÔÓ·. ∏ ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ Ù˘ ÙÔ͛Ӣ ‹Ù·Ó ηٿ̤ÛÔ fiÚÔ 10 ‚‰ÔÌ¿‰Â˜ Î·È ‰ÂÓ apple·ÚÔ˘ÛÈ¿ÛıËÎ·Ó ÂappleÈappleÏÔΤ˜‹ ÔÊı·ÏÌÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û ηӤӷ appleÂÚÈ-ÛÙ·ÙÈÎfi. ˘ÌappleÂÚ¿ÛÌ·Ù·: ∏ ¯Ú‹ÛË Ù˘ ·ÏÏ·ÓÙÔÙÔ͛Ӣ·appleÔÙÂÏ› Ì›· ·ÛÊ·Ï‹ Î·È ·appleÔÙÂÏÂÛÌ·ÙÈ΋ ̤ıÔ‰Ô appleÚfi-ÛηÈÚ˘ ·ÓÙÈÌÂÙÒappleÈÛ˘ ÙÔ˘ Û˘Ìappleو̷ÙÈÎÔ‡ Ï·ÁfiÊı·Ï-ÌÔ˘ ·applefi apple·Ú¿Ï˘ÛË ÙÔ˘ appleÚÔÛˆappleÈÎÔ‡ Ó‡ÚÔ˘.Introduction: Upper lid retraction secondary to seventhnerve palsy may result in lagophthalmos, incomplete corneaprotection and exposure keratopathy. We present ourexperience from the use of Botulinum toxin type A in themanagement of upper lid retraction by inducing chemicaldenervation of the levator muscle. Patients – Methods:Eighteen patients with recent onset of seventh nerve palsyand symptomatic lagophthalmos with exposure keratopathynot responding to artificial tear topical medicationswere included. With an insulin syringe 7,5-15 IU of Botulinumtoxin were infused through the middle of the upper liddeep, towards the orbital apex, above Whitnall’s ligamentand levator muscle. Palpebral aperture, levator functionand lagophthalmos before and after infusion were recordedon regular post treatment intervals. Results: Lagophthalmosimprovement and corneal protection was a-chieved in all patients. Upper lid retraction was reducedwith lid covering the upper limbus whereas in only twocases the visual axis was obstructed. Chemical denervationlasted for a mean period of 10 weeks. No complicationsor extraocular muscle involvement was recorded inany of the patients during the post treatment period.Conclusions: Botulinum toxin application is a safe andeffective alternative in the temporary management of symptomaticlagophthalmos due to seventh nerve palsy.OÊı·ÏÌÔÏÔÁÈ΋ KÏÈÓÈ΋ AÚÈÛÙÔÙÂÏ›Ԣ ·ÓÂappleÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢OÊı·ÏÌÔÏÔÁ›·, 14, 2 : 177 - 183, 2002 177