Riolan's muscle: action and indications for botulinum toxin injection.

PURPOSE: To study the effect of injecting botulinum toxin into the region of Riolan's muscle in three conditions, namely the typical form of essential blepharospasm, the palpebral form of essential blepharospasm and hemifacial spasm.

METHOD: Six patients with the typical form of essential blepharospasm and 4 patients with the palpebral form of essential blepharospasm, all of whom had previously been treated with conventional bilateral periorbital injections, were treated with injections of the toxin into the region of Riolan's muscle at the medial and lateral extremities of the upper lids. Thirty patients with hemifacial spasm, all of whom had previously been treated with conventional periorbital injections, were treated with injections of the toxin into the region of Riolan's muscle at the medial and lateral extremities of the upper lid on the affected side.

RESULTS

Five of 6 patients with typical essential blepharospasm preferred the Riolan's injections and one had no preference. All of the four patients with the palpebral form of essential blepharospasm preferred the Riolan's injections. They, previously, had hardly been able to open their eyes. Twenty-six of the patients with hemifacial spasm preferred the Riolan's injections; the other 4 decided to continue with periorbital injections. The amount of toxin used in this new method of treatment is considerably less than that used in conventional methods for these diseases.

CONCLUSION

Riolan's injections of botulinum toxin are the preferred modality of treatment for all types of blepharospasm and cost considerably less.