Hamzah Mustak1,2, Michael Rafaelof1,2, Robert Alan Goldberg1,2, Daniel Rootman1,2. 1. Drs. Mustak, Goldberg, and Rootman and Mr. Rafaelof are with the Stein Eye Institute, Division of Orbital and Oculoplastic Surgery at the University of California, Los Angeles in Los Angeles, California. 2. Dr. Mustak is also with the Groote Schuur Hospital, Division of Ophthalmology, University of Cape Town in Cape Town, South Africa.
Abstract
Background: Lid margin asymmetry and its associated compensatory mechanisms might cause patients to seek treatment to improve aesthetics. Surgery might not be indicated and can potentially worsen the asymmetry in these cases. Methods: A case series of three patients was organized to illustrate the use of botulinum toxin administered to the pre-tarsal orbicularis for the correction of micro-ptosis and improved symmetry. The marginal reflex distance and tarsal platform show were measured on both sides. Measurements were made using ImageJ software on standardized frontal photographs taken pre- and post-injection. Results: The average increase in the marginal reflex distance was 0.914mm, with an average pre-tarsal botulinum toxin dose of three units. The average change in tarsal platform show between the two eyes was 0.89mm. Conclusion: Botulinum toxin application to the pre-tarsal orbicularis oculi muscle might be a suitable option for the management of small eyelid margin asymmetries.
Background: Lid margin asymmetry and its associated compensatory mechanisms might cause patients to seek treatment to improve aesthetics. Surgery might not be indicated and can potentially worsen the asymmetry in these cases. Methods: A case series of three patients was organized to illustrate the use of botulinum toxin administered to the pre-tarsal orbicularis for the correction of micro-ptosis and improved symmetry. The marginal reflex distance and tarsal platform show were measured on both sides. Measurements were made using ImageJ software on standardized frontal photographs taken pre- and post-injection. Results: The average increase in the marginal reflex distance was 0.914mm, with an average pre-tarsal botulinum toxin dose of three units. The average change in tarsal platform show between the two eyes was 0.89mm. Conclusion: Botulinum toxin application to the pre-tarsal orbicularis oculi muscle might be a suitable option for the management of small eyelid margin asymmetries.