Effect of Topical Botulinum Toxin Eyedrop on Palpebral Fissure

Recruitment & Eligibility

Inclusion Criteria

Adults aged 18 and above that present to the oculoplastic and reconstructive surgery department that are able to provide informed consent to participate
Presence of upper eyelid retraction or asymmetry( >1mm)

Exclusion Criteria

Adults unable to consent
Individuals less than 18 years of age
Prisoners
Pregnant women. o Patients will be asked if they are pregnant by research staff before participation in the study.

Women who are breast-feeding

Known contradictions or sensitivities to study medication
Grossly abnormal lid margins, anatomical abnormalities
Variable ptosis or eyelid position (e.g., myasthenia gravis, blepharospasm)
Any ocular or systemic condition that, in the opinion of the investigator, would confound study data, interfere with the subject's study participation, or affected the subject's safety or trial parameters
Presence of an active ocular infection
Inability to sit comfortably for 15 - 30 minutes
Botulinum toxin injection in the eyelids during the past 3 weeks.
Neuromuscular disorders (e.g., Parkinson's disease or myasthenia gravis)
Medication use known to interfere with the effects of botulinum toxin-A within the previous 1 month (e.g., aminoglycoside or benzodiazepines),
Previous history of hypersensitivity reactions to botulinum toxin-A
Dysfunction of tear production or secretion (e.g., meibomian gland dysfunction or Sjogren's syndrome),

Study & Design

Arm && Interventions

Group	Intervention	Description
Botulinum toxin group	Botulinum toxin	The left eye of each participant will receive botulinum toxin eye drops and will remain in this group for up to 40 minutes.

Primary Outcome Measures

Name	Time	Method
Change in Palpebral Fissure Height	baseline and Day 3	Palpebral fissure on Day 3 minus palpebral fissure at baseline. Palpebral fissure is the area between the upper and lower eyelid margins. Palpebral fissure height on eyes is measured in primary gaze position with a clear ruler held in a central vertical position between the upper and lower eyelid margin.

Secondary Outcome Measures

Name	Time	Method
Corneal Staining Density	Day 3	Scoring of the ocular surface will be done by fluorescein staining and evaluating with a slit lamp and grading scale: 0-3 0 (no punctate staining) 1. (sparse density) 2. (moderate density) 3. (high density and overlapping lesions).
Change in Tearing	baseline and Day 3	Change in tearing will be calculated as tearing on Day 3 minus tearing at baseline. Tearing will be assessed using the Schirmer test with anesthesia. Schirmer strip is inserted into the lower conjunctival sac at the junction of the lateral and middle thirds, avoiding touching the cornea, and the length of wetting strips in millimeters is recorded after 5 minutes. The result can range from a minimum of 0 mm (no tearing) to a maximum of 35 mm (maximum tearing).

Recruitment & Eligibility