BEBRF 2021 SYMPOSIUM FIRST QUESTION AND ANSWER SESSION MODERATOR: DR. JURIJ BILYK | PANEL: DR. APRIL LAO, DR. ALISON WATSON REPORTED BY PETER BAKALOR
Q: Do you change your injection pattern for Apraxia of Eyelid opening? A: Dr. Watson: It depends on if there is an accompanying spasm. I usually start out with my standard treatment pattern then modify based on the patient’s feedback. Q: How long does it take for Lidocaine gel to work? A: Dr. Watson: It has to be on there for 15 to 30 minutes to work. I generally don’t use it with my patients because of concern that it might impact efficacy. Comment by Dr. Bilyk: When I prescribe it, I have it put on when the patient arrives, or even at home before hand, as it takes a while to become effective. Q: If concerned about zinc levels, is it OK to just take a multi-vitamin? A: Dr. Watson: Certainly, taking a multivitamin with zinc in it is more than enough. If your botulinum toxin is not working you might want to investigate with your doctor, especially if they think there might be absorption issues limiting the efficacy of the multivitamin. Q: Please talk more about Brimonidine A: Dr. Watson: Brimonidine is a drug that’s used for glaucoma. It uses a different path to target the Mueller muscle in a way that stimulates it to raise the eyelid a little. It’s a different muscle than the one impacted by botulinum toxin. Comment by Dr. Bilyk: It doesn’t work for everyone, but it’s covered by insurance as a glaucoma medicine. Q: Where could I get ptosis crutches put on my glasses? A: Dr. Bilyk: Ptosis crutches are made by adding a wire to the back of the glasses above the lens, so that when you put them on, the wire pushes against the skin of the eyelid and raises it. Use is for Apraxia and other paralytic situations. There aren’t too many places that make it. It is difficult to fit and you can’t send away for it. Also, it creates a static situation, whereas the lid is dynamic and goes up and down. With the crutch, the lid stays up and dries out the eye, and requires frequent drops 10
If your botulinum toxin is not working you might want to investigate with your doctor, especially if they think there might be absorption issues limiting the efficacy of the multivitamin. to deal with that. I use them infrequently, and they are not a panacea. The best place to find them is to look for a University Ophthalmology department that has an optical shop, and they may be able to help. Q: Other than for insurance reasons, is there any reason to use Dysport over other botulinum toxins? A: Dr. Watson: Generally, it might be used if Botox or Xeomin are not working well for the patient. Anecdotally I believe it disperses more which can be advantageous but does create the worry of it spreading to unintended areas. I haven’t seen that in my patients, but other than just trying to find something that works well I don’t use it. Comment by Dr. Bilyk: It is a very good drug, and it works well, so if you are on Dysport and it is working, stay on Dysport. It is as effective as the other two approved medications – it is just that it is tricky getting the equivalent dose right if one is switching. Q: What oral medications are available for Meige? A: Dr. Lao: There are anticholinergic medications that are usually used more by Neurologists for movement disorders and issues of that nature, so better to refer that to them. Comment by Dr. Bilyk: I don’t think anyone on the panel prescribes them because there are side effects, and you really need someone that is more familiar with them to prescribe them, and that’s usually a Neurologist. Q: For injections, please clarify what you mean by volume and what you mean by dose, and generally who reconstitutes and mixes the toxin?
