IMPORTANCE: While surgical procedure has been considered as the golden standard treatment of spasmodic entropion, Botulinum Neurotoxin A is indicated for fragile elderly patients.
Current literature, however, is week about this subject, and many practitioners administered BT with irregular dosage and variable location of injection.
OBJECTIVE: The intent of the present study was to describe an alternative outdoor treatment, to precise the Botulinum Neurotoxin (BT) treatment pattern, the superiority of one of the three main botulinum toxin A, the dosage of BT needed, the frequency of re-injection, the efficiency and the complications encountered.
DESIGN: A study from 2002 to 2020, including 50 outdoor patients treated for spasmodic entropion, for whom palpebral surgery was recused.
We have treated 50 patients, 87.9 years old in average (± 14,3).
The average total dosage of BT is 7,62 ± 1,38 units of Incobotulinum, 10,2 ± 1,03 units of Onabotulinum and 17,2 ± 1,33 Speywood-units of Abobotulinum.
Spasmodic entropion resolved in 3 days ± 2 after the BT injection.
The average of re-injection is every 4.25 months ± 1.30.
By adjusting age and total dose, we have not been able to show any statistically significant relationship between time needed for re-injection and type of botulinum toxin A (p = 0.46).
Surgical treatment of senile entropion is more reliable and persistent and must remain the golden standard treatment.
However botulinum toxin A has the advantage to be easy to use and it’s a very secured process, wich can be given at the initial consultation and may have a role to play for patients where there is a long waiting list for surgery, or in those unable or unwilling to have an operation, and in the few cases where temporary relief of the spasmodic entropion is needed.
It is possible that repeated injections would induce muscular atrophy resulting in a decrease of the spasmodic entropion, but no ethical study can confirm it.
Patients with spasmodic entropion responded significantly to Botulinum treatment. No systemic complications had been reported in this study. BT injection is safe and effective for fragile elderly patients with spasmodic entropion and can be proposed instead of surgery or while waiting for their procedure.
