Benign Essential Blepharospasm Medication

Updated: Jul 20, 2018
  • Author: Robert H Graham, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.


Botulinum toxins

Class Summary

Help produce symptomatic improvement of orbicularis spasm and autonomic symptoms.

The various botulinum toxins possess individual potencies and care is required to assure proper use and avoid medication errors. Recent changes to the established drug names by the FDA were intended to reinforce these differences and prevent medication errors. The products and their approved indications include:

- OnabotulinumtoxinA (Botox, Botox Cosmetic)

-- Botox: cervical dystonia, severe primary axillary hyperhidrosis, strabismus, blepharospasm

-- Botox Cosmetic: moderate-to-severe glabellar lines

- AbobotulinumtoxinA (Dysport): cervical dystonia, moderate-to-severe glabellar lines

- IncobotulinumtoxinA (Xeomin): cervical dystonia, blepharospasm

- RimabotulinumtoxinB (Myobloc): cervical dystonia

OnabotulinumtoxinA (BOTOX ®)

Treats excessive, abnormal contractions associated with blepharospasm. Binds to receptor sites on motor nerve terminals and inhibits release of ACh, which, in turn, inhibits transmission of impulses in neuromuscular tissue.

Reexamine patients 7-14 d after initial dose to assess for response. Increase doses 2-fold over previous dose for patients experiencing incomplete paralysis of target muscle. Do not exceed 25 U when giving it as single injection or 200 U as cumulative dose in 30-day period.

IncobotulinumtoxinA (Xeomin)

Botulinum toxin type A that is free of complexing proteins found in natural toxin from Clostridium botulinum. Acetylcholine release inhibitor and neuromuscular blocking agent. Indicated for blepharospasm in adults previously treated with onabotulinumtoxinA (Botox).