Treatment of blepharospasm with high dose brow injection of botulinum toxin.

We treated 12 patients who had essential blepharospasm with brow and eyelid injections of botulinum toxin. The eyelid injections were kept constant while varying doses were used in the brow. The duration of the effect of the toxin was longer and the degree of improvement greater in those patients receiving more than 20 U in the brow than in those receiving less than 20 U. However, the degree of improvement in spasm intensity in those patients receiving greater than 20 U was similar. Ptosis occurred in seven patients. No systemic side effects were noted.